Provider Demographics
NPI:1376560037
Name:WASILKO, ROBERTA (OT)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:WASILKO
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:ROBERTA
Other - Middle Name:
Other - Last Name:MORSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19266 COASTAL HWY
Practice Address - Street 2:SHOPS AT SEA COAST
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-6117
Practice Address - Country:US
Practice Address - Phone:302-226-2230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00102900225X00000X
DEU1-0001063225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist