Provider Demographics
NPI:1275817488
Name:WILCOX, ELIZABETH YVONNE (LMT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:YVONNE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HOTCHKISS RD
Mailing Address - Street 2:
Mailing Address - City:SLAB FORK
Mailing Address - State:WV
Mailing Address - Zip Code:25920-9505
Mailing Address - Country:US
Mailing Address - Phone:304-774-0076
Mailing Address - Fax:304-774-0188
Practice Address - Street 1:129 MAIN ST
Practice Address - Street 2:SUITE 608 UNITED BANK COMPLEX
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4615
Practice Address - Country:US
Practice Address - Phone:304-575-5296
Practice Address - Fax:304-774-0188
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-06
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1999-0234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist