Provider Demographics
NPI:1376921650
Name:VIK, ERICA ANNE
Entity Type:Individual
Prefix:MISS
First Name:ERICA
Middle Name:ANNE
Last Name:VIK
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 1:214 5TH AVE E
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:WI
Mailing Address - Zip Code:54806-1832
Mailing Address - Country:US
Mailing Address - Phone:563-217-2020
Mailing Address - Fax:
Practice Address - Street 1:214 5TH AVE E
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:WI
Practice Address - Zip Code:54806-1832
Practice Address - Country:US
Practice Address - Phone:563-217-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-07
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX212672224ZE0001X
IDOTA-1433224ZE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224ZE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantEnvironmental Modification