Provider Demographics
NPI:1386915809
Name:BICKLEY, WILLIS (BOCP)
Entity type:Individual
Prefix:
First Name:WILLIS
Middle Name:
Last Name:BICKLEY
Suffix:
Gender:M
Credentials:BOCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 LINDEN LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-1230
Mailing Address - Country:US
Mailing Address - Phone:301-585-5347
Mailing Address - Fax:
Practice Address - Street 1:2421 LINDEN LN
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-1230
Practice Address - Country:US
Practice Address - Phone:301-585-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC21593224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist