Provider Demographics
NPI:1427722941
Name:WILKES, JAMIE LYNN (COTA/L)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:WILKES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 PINES KNOLL DR APT B
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5161
Mailing Address - Country:US
Mailing Address - Phone:478-298-9008
Mailing Address - Fax:
Practice Address - Street 1:631 PINES KNOLL DR APT B
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5161
Practice Address - Country:US
Practice Address - Phone:478-298-9008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-07
Last Update Date:2021-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOTA001055224Z00000X
FLOTA18445224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant