Provider Demographics
NPI:1326194432
Name:WIGGINS, JOAN
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5300 N GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5647
Mailing Address - Country:US
Mailing Address - Phone:405-778-6900
Mailing Address - Fax:405-778-6914
Practice Address - Street 1:5300 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-5647
Practice Address - Country:US
Practice Address - Phone:405-778-6900
Practice Address - Fax:405-778-6914
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK146225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181887401Medicaid