Provider Demographics
NPI:1053067686
Name:WILKIE, GENNA (OTR/L)
Entity type:Individual
Prefix:
First Name:GENNA
Middle Name:
Last Name:WILKIE
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11102 RUNYAN LN
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-1835
Mailing Address - Country:US
Mailing Address - Phone:586-206-5548
Mailing Address - Fax:
Practice Address - Street 1:23715 LITTLE MACK AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1181
Practice Address - Country:US
Practice Address - Phone:586-447-4070
Practice Address - Fax:586-447-4069
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5201011336225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist