Provider Demographics
NPI:1508005901
Name:WILKES, CHRISTOPHER WALLACE (OTR/L)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:WALLACE
Last Name:WILKES
Suffix:
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 BAY SPRINGS CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:GA
Mailing Address - Zip Code:31002-4247
Mailing Address - Country:US
Mailing Address - Phone:478-668-3428
Mailing Address - Fax:
Practice Address - Street 1:1350 BAY SPRINGS CHURCH RD
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:GA
Practice Address - Zip Code:31002-4247
Practice Address - Country:US
Practice Address - Phone:478-668-3428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004805225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist