Individual
MISS MARY WICKERT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13800 W 116TH ST, OLATHE, KS 66062-7833
(913) 323-7129
Mailing address
9206 W 73RD ST APT 206, MERRIAM, KS 66204-1633
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
14-02037
KS
Other
Enumeration date
05/27/2010
Last updated
05/27/2010
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