Provider Demographics
NPI:1003083858
Name:FYKSEN, JILL VICTORIA (OTD OTR/L)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:VICTORIA
Last Name:FYKSEN
Suffix:
Gender:F
Credentials:OTD OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2378 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:WI
Mailing Address - Zip Code:53910-9722
Mailing Address - Country:US
Mailing Address - Phone:608-547-9881
Mailing Address - Fax:
Practice Address - Street 1:2378 11TH AVE
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:WI
Practice Address - Zip Code:53910-9722
Practice Address - Country:US
Practice Address - Phone:608-547-9881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3856-026225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist