Individual
TIMOTHY WALLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
212 SUNRISE DR, CLARKSON, NE 68629-4042
(402) 892-3494
Mailing address
2105 SHERIDAN DR, NORFOLK, NE 68701-2056
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2117
NE
Other
Enumeration date
10/28/2021
Last updated
10/28/2021
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