Provider Demographics
NPI:1649235284
Name:WILKIN, AMY LOUISE (AT,C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LOUISE
Last Name:WILKIN
Suffix:
Gender:F
Credentials:AT,C
Other - Prefix:MISS
Other - First Name:AMY
Other - Middle Name:LOUISE
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AT,C
Mailing Address - Street 1:20968 HAZEL RD
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92308
Mailing Address - Country:US
Mailing Address - Phone:760-240-4263
Mailing Address - Fax:
Practice Address - Street 1:18422 BEAR VALLEY RD
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-5850
Practice Address - Country:US
Practice Address - Phone:760-245-4271
Practice Address - Fax:760-843-7726
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer