Individual
GENEVA WICKIZER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
13030 WARWICK BLVD, NEWPORT NEWS, VA 23602-8374
(757) 249-0355
Mailing address
358 WATERFOWL LN, NEWPORT NEWS, VA 23602-7564
(757) 879-3128
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131001479
VA
Other
Enumeration date
10/01/2017
Last updated
10/01/2017
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