Provider Demographics
NPI:1205178076
Name:WIKARSKA, CAROL WIERZBINSKI (LMT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:WIERZBINSKI
Last Name:WIKARSKA
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 NORWICH AVE
Mailing Address - Street 2:
Mailing Address - City:COLCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06415-1269
Mailing Address - Country:US
Mailing Address - Phone:860-537-1915
Mailing Address - Fax:
Practice Address - Street 1:108 NORWICH AVE
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06415-1269
Practice Address - Country:US
Practice Address - Phone:860-537-1915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000703225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist