Provider Demographics
NPI:1457567752
Name:WICKER, KEVIN A (CPO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:WICKER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1603 S STERLING ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-4097
Mailing Address - Country:US
Mailing Address - Phone:828-391-5164
Mailing Address - Fax:828-391-5011
Practice Address - Street 1:1603 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-4097
Practice Address - Country:US
Practice Address - Phone:828-391-5164
Practice Address - Fax:828-391-5011
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist