Provider Demographics
NPI:1598543720
Name:CLICK, VICTORIA ALEXIS (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:ALEXIS
Last Name:CLICK
Suffix:
Gender:F
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 1:605 WOLFPEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MALLIE
Mailing Address - State:KY
Mailing Address - Zip Code:41836-8853
Mailing Address - Country:US
Mailing Address - Phone:859-979-9028
Mailing Address - Fax:
Practice Address - Street 1:388 PERKINS MADDEN RD
Practice Address - Street 2:
Practice Address - City:HINDMAN
Practice Address - State:KY
Practice Address - Zip Code:41822-9003
Practice Address - Country:US
Practice Address - Phone:606-785-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY287565225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist