Provider Demographics
NPI:1407200199
Name:WAWCHUK, AIDAN
Entity Type:Individual
Prefix:MISS
First Name:AIDAN
Middle Name:
Last Name:WAWCHUK
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 1:1021 POINT VISTA RD
Mailing Address - Street 2:APT 3204
Mailing Address - City:HICKORY CREEK
Mailing Address - State:TX
Mailing Address - Zip Code:75065-7647
Mailing Address - Country:US
Mailing Address - Phone:940-279-1391
Mailing Address - Fax:
Practice Address - Street 1:5701 VIRGINIA PKWY
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-5652
Practice Address - Country:US
Practice Address - Phone:972-905-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX117536225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist