Provider Demographics
NPI:1548478589
Name:WICKLUND, JOYCE ANN (OT)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:ANN
Last Name:WICKLUND
Suffix:
Gender:F
Credentials:OT
Other - Prefix:MS
Other - First Name:JOYCE
Other - Middle Name:ANN
Other - Last Name:WICKLUND, OTR/L
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OTR/L
Mailing Address - Street 1:2353 23RD ST
Mailing Address - Street 2:EUREKA HEALTH & WELLNESS CENTER, OT DEPT.
Mailing Address - City:EUREKA
Mailing Address - State:CA
Mailing Address - Zip Code:95501-3201
Mailing Address - Country:US
Mailing Address - Phone:707-445-3261
Mailing Address - Fax:
Practice Address - Street 1:2353 23RD ST.,
Practice Address - Street 2:EUREKA HEALTH & WELLNESS CENTER, OT DEPT.
Practice Address - City:EUREKA
Practice Address - State:CA
Practice Address - Zip Code:95501
Practice Address - Country:US
Practice Address - Phone:707-445-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9270225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist