Individual
MELINDA SUE WICIAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1560 HENTHORNE DR, MAUMEE, OH 43537-1371
(419) 866-5196
(419) 866-5663
Mailing address
1560 HENTHORNE DR, MAUMEE, OH 43537-1371
(419) 866-5196
(419) 866-5663
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT004776
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0392980
—
OH
01
—
1609899061
COMPANY NPI
OH
Enumeration date
02/02/2017
Last updated
06/14/2021
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