Provider Demographics
NPI:1356824809
Name:WIKOFF, MARILYN SUE (PT)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:SUE
Last Name:WIKOFF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6988 TOMAHAWK TRL
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4806
Mailing Address - Country:US
Mailing Address - Phone:614-657-4881
Mailing Address - Fax:
Practice Address - Street 1:526 N CASSADY AVE
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-1033
Practice Address - Country:US
Practice Address - Phone:614-246-5093
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0021002251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatricsGroup - Single Specialty