Individual
EMILY ANNE WICKENKAMP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
100 N MARIO CAPECCHI DR, SALT LAKE CITY, UT 84113-1103
(801) 662-1234
Mailing address
PO BOX 30180, SALT LAKE CITY, UT 84130-0180
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
12625454-4201
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300021481
—
IN
Enumeration date
11/01/2018
Last updated
04/12/2022
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