Provider Demographics
NPI:1073020954
Name:WILKINS, JOSEPH C (MED, AT, CSCS)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:C
Last Name:WILKINS
Suffix:
Gender:M
Credentials:MED, AT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 S GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-2004
Mailing Address - Country:US
Mailing Address - Phone:614-823-3520
Mailing Address - Fax:
Practice Address - Street 1:1 S GROVE ST
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2004
Practice Address - Country:US
Practice Address - Phone:614-823-3520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAT0020042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer