Individual
AMY LEE WICKHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14196 NATIONAL RD SW, ETNA, OH 43068-3365
(740) 927-6782
Mailing address
6992 OPTIMARA DR, PICKERINGTON, OH 43147-7766
(614) 561-7577
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
04376
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04376
LICENSE NUMBER
OH
Enumeration date
06/24/2020
Last updated
06/24/2020
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