Provider Demographics
NPI:1639478167
Name:PICKETT, RICKEY WAYNE (OT)
Entity Type:Individual
Prefix:
First Name:RICKEY
Middle Name:WAYNE
Last Name:PICKETT
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 S 10TH ST
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1708
Mailing Address - Country:US
Mailing Address - Phone:717-943-1888
Mailing Address - Fax:717-943-1887
Practice Address - Street 1:319 S 10TH ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1708
Practice Address - Country:US
Practice Address - Phone:717-943-1888
Practice Address - Fax:717-943-1887
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004934L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist