Individual
KAYLA WICKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPO, LPO
Contact information
Practice address
1516 HUDSON ST STE 105, LONGVIEW, WA 98632-3046
(360) 423-6049
Mailing address
830 GISH RD, ONALASKA, WA 98570-9529
(253) 797-5163
Taxonomy
Speciality
Code
Description
License number
State
222Z00000X
Orthotist
Primary
OI61230221
WA
224P00000X
Prosthetist
PS61132736
WA
Other
Enumeration date
11/11/2021
Last updated
11/11/2021
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