Provider Demographics
NPI:1619213238
Name:WILKINS, SAMUEL J (ATC)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:J
Last Name:WILKINS
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 DODGE ST
Mailing Address - Street 2:HPER 207
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68182-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6001 DODGE ST
Practice Address - Street 2:HPER 207
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68182-1102
Practice Address - Country:US
Practice Address - Phone:402-554-3254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5382255A2300X, 2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer