Provider Demographics
NPI:1194141531
Name:WILKER, NORMA
Entity type:Individual
Prefix:MS
First Name:NORMA
Middle Name:
Last Name:WILKER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NORMA
Other - Middle Name:
Other - Last Name:GOUBEAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:4801 SPRINGFIELD ST.
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431
Mailing Address - Country:US
Mailing Address - Phone:937-236-9965
Mailing Address - Fax:937-233-0161
Practice Address - Street 1:4801 SPRINGFIELD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45431-1084
Practice Address - Country:US
Practice Address - Phone:937-236-9965
Practice Address - Fax:937-233-0161
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT002963225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOT.002963OtherOHIO LICENSE CENTER; OT/PT/ATHLETIC ICENSURE BOARD