Provider Demographics
NPI:1003679051
Name:WILKINSON, GRADY
Entity Type:Individual
Prefix:
First Name:GRADY
Middle Name:
Last Name:WILKINSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8877 MADDEN RD
Mailing Address - Street 2:
Mailing Address - City:LYNNVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47619-8265
Mailing Address - Country:US
Mailing Address - Phone:618-262-1267
Mailing Address - Fax:
Practice Address - Street 1:714 S EICKHOFF RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-9006
Practice Address - Country:US
Practice Address - Phone:812-985-9878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31008196A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist