Individual
MR. JEFFREY W WICKLINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
3260 OCEANIC BAY DR, SOUTHPORT, NC 28461-6401
(203) 217-9366
Mailing address
1222 MATTEO DRIVE, WILMINGTON, NC 28412-1000
(203) 217-9366
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
001758
CT
225X00000X
Occupational Therapist
Primary
9721
NC
Other
Enumeration date
07/14/2014
Last updated
12/09/2020
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