Provider Demographics
NPI:1922005198
Name:WILKENING, CHERYL LYNN (OT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:WILKENING
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5901 STEEPLECHASE RD
Mailing Address - Street 2:
Mailing Address - City:BONITA
Mailing Address - State:CA
Mailing Address - Zip Code:91902-3041
Mailing Address - Country:US
Mailing Address - Phone:904-504-0520
Mailing Address - Fax:
Practice Address - Street 1:5901 STEEPLECHASE RD
Practice Address - Street 2:
Practice Address - City:BONITA
Practice Address - State:CA
Practice Address - Zip Code:91902-3041
Practice Address - Country:US
Practice Address - Phone:904-504-0520
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-04
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11280225X00000X
FL11784225X00000X
GA003686225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist