Provider Demographics
NPI:1073635199
Name:WIKSTROM, APRIL MERRILEE (OTD-R/L)
Entity Type:Individual
Prefix:
First Name:APRIL
Middle Name:MERRILEE
Last Name:WIKSTROM
Suffix:
Gender:F
Credentials:OTD-R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:353 CAROLINA MTN DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-2768
Mailing Address - Country:US
Mailing Address - Phone:828-342-5910
Mailing Address - Fax:828-558-4344
Practice Address - Street 1:175B E MAIN ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3045
Practice Address - Country:US
Practice Address - Phone:828-342-5910
Practice Address - Fax:828-558-4344
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225X00000X
NC11179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24001023Medicaid
CO660410OtherBLUE CROSS
CO805344Medicare ID - Type Unspecified