Provider Demographics
NPI:1508857087
Name:WICK, CAROL M (PT, OTR/L)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:M
Last Name:WICK
Suffix:
Gender:F
Credentials:PT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38600 VEAZIE CUMBERLAND RD SE
Mailing Address - Street 2:
Mailing Address - City:ENUMCLAW
Mailing Address - State:WA
Mailing Address - Zip Code:98022-7708
Mailing Address - Country:US
Mailing Address - Phone:253-709-0371
Mailing Address - Fax:360-802-2345
Practice Address - Street 1:2355 GRIFFIN AVE
Practice Address - Street 2:SUITE D
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-2440
Practice Address - Country:US
Practice Address - Phone:253-709-0371
Practice Address - Fax:360-802-2345
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00000742225100000X
WAOT00000204225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist