Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 5759 | AL |
NPI | 1023761244 |
---|---|
Provider Name | Victoria Wicks |
First Address | Birmingham, AL 35205-1208 |
Second Address | Vestavia Hills, AL 35216-1840 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2022 |
Last Update Date | 28/01/2022 |