Provider Demographics
NPI:1033460456
Name:WHEELER, LYDIA LEOPOLDINA
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:LEOPOLDINA
Last Name:WHEELER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:721 N K ST
Mailing Address - Street 2:APT. #6
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-2464
Mailing Address - Country:US
Mailing Address - Phone:714-310-0852
Mailing Address - Fax:
Practice Address - Street 1:3035 CHERRY ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3007
Practice Address - Country:US
Practice Address - Phone:360-532-7882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT 00004220225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist