Provider Demographics
NPI:1669722112
Name:VICK, NORMAN DWIGHT
Entity type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:DWIGHT
Last Name:VICK
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:NORMAN
Other - Middle Name:DWIGHT
Other - Last Name:VICK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:50 AZALEA DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-3734
Mailing Address - Country:US
Mailing Address - Phone:757-723-7522
Mailing Address - Fax:
Practice Address - Street 1:50 AZALEA DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23669-3734
Practice Address - Country:US
Practice Address - Phone:757-723-7522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist