Individual
MS. AZALYN HICKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1787 ALLENDALE FAIRFAX HWY, FAIRFAX, SC 29827-9133
(803) 632-3311
Mailing address
5830 CORAL RIDGE DR STE 300, CORAL SPRINGS, FL 33076-3388
(954) 510-4045
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
4741
AL
225X00000X
Occupational Therapist
Primary
5161
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1033106596
ALDEN LAKELAND
SC
Enumeration date
08/14/2018
Last updated
08/14/2018
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