Provider Demographics
NPI:1982855862
Name:WIKIE, EMILY TERESA (PTA)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:TERESA
Last Name:WIKIE
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:MISS
Other - First Name:EMILY
Other - Middle Name:TERESA
Other - Last Name:STROUD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:90 TWIN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014
Mailing Address - Country:US
Mailing Address - Phone:406-853-2594
Mailing Address - Fax:
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220
Practice Address - Country:US
Practice Address - Phone:513-872-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-09
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPTA06464225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant