Individual
MARY BETH WICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
12203 CORPORATE PKWY, MEQUON, WI 53092-3388
(262) 387-8200
(262) 387-8271
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
289
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40789400
—
WI
01
—
P00477562
RR MEDICARE
WI
Enumeration date
07/05/2006
Last updated
04/09/2025
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