Individual
KALYN MASHAE WICKLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.O.T.
Contact information
Practice address
600 GREGORY AVE, WEEHAWKEN, NJ 07086-5814
(860) 417-8158
Mailing address
600 GREGORY AVE, WEEHAWKEN, NJ 07086-5814
(860) 417-8158
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
016760
NY
225X00000X
Occupational Therapist
Primary
46TR00605700
NJ
Other
Enumeration date
05/18/2011
Last updated
07/07/2015
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