Provider Demographics
NPI:1881780575
Name:BICKHAM, NONA W (RKT)
Entity type:Individual
Prefix:MRS
First Name:NONA
Middle Name:W
Last Name:BICKHAM
Suffix:
Gender:F
Credentials:RKT
Other - Prefix:MRS
Other - First Name:NONA
Other - Middle Name:W
Other - Last Name:BICKHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RKT
Mailing Address - Street 1:3517 HAZEL ST
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3716
Mailing Address - Country:US
Mailing Address - Phone:870-779-2725
Mailing Address - Fax:870-779-2740
Practice Address - Street 1:910 REALTOR AVE
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-1020
Practice Address - Country:US
Practice Address - Phone:870-779-2725
Practice Address - Fax:870-779-2740
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1724226300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes226300000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersKinesiotherapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1724OtherREGISTRATION