Provider Demographics
NPI:1801358288
Name:WILHELM-WILSON, NICOLE EKIKA YAEKO (LMT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:EKIKA YAEKO
Last Name:WILHELM-WILSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520-2138
Mailing Address - Country:US
Mailing Address - Phone:541-944-0909
Mailing Address - Fax:
Practice Address - Street 1:550 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-2138
Practice Address - Country:US
Practice Address - Phone:541-944-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR22185225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist