Provider Demographics
NPI:1447594981
Name:WIKLUND, LINDA M (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:M
Last Name:WIKLUND
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1668 E SICILY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-1449
Mailing Address - Country:US
Mailing Address - Phone:208-286-4075
Mailing Address - Fax:
Practice Address - Street 1:1668 E SICILY ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-1449
Practice Address - Country:US
Practice Address - Phone:208-286-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-21
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDOTA-116224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant