Provider Demographics
NPI:1093045379
Name:WHEELER, VICKY LYNN (COTA)
Entity Type:Individual
Prefix:
First Name:VICKY
Middle Name:LYNN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 292
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:54858-0292
Mailing Address - Country:US
Mailing Address - Phone:715-825-3539
Mailing Address - Fax:
Practice Address - Street 1:620 PARKINS AVENUE
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:WI
Practice Address - Zip Code:54858
Practice Address - Country:US
Practice Address - Phone:715-825-3539
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-08
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4733-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant