Individual
MS. SALLY ANN WICKMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3417 TAMIAMI TRL STE A, PORT CHARLOTTE, FL 33952-8158
(941) 624-6222
(941) 624-6821
Mailing address
336 SHORE RD, VENICE, FL 34285-3725
(941) 488-7313
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT6185
FL
Other
Enumeration date
06/20/2007
Last updated
07/08/2007
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