Provider Demographics
NPI:1952691727
Name:WIHLEN, TRACI ANNE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:ANNE
Last Name:WIHLEN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:ANNE
Other - Last Name:BOARDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:COTA
Mailing Address - Street 1:40 TRILLIUM LN
Mailing Address - Street 2:
Mailing Address - City:WEST HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14586-9513
Mailing Address - Country:US
Mailing Address - Phone:585-339-1555
Mailing Address - Fax:
Practice Address - Street 1:600 PARDEE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-2810
Practice Address - Country:US
Practice Address - Phone:585-339-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001560224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AA555243OtherNATIONAL BOARD FOR CERTIFICATION OF OCCUPATIONAL THERAPY