Provider Demographics
NPI:1285039560
Name:WILCOX, JAMIESON (OTD)
Entity Type:Individual
Prefix:DR
First Name:JAMIESON
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 HIGHLAND AVE
Mailing Address - Street 2:UNIT D
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-5552
Mailing Address - Country:US
Mailing Address - Phone:310-462-6612
Mailing Address - Fax:
Practice Address - Street 1:903 HIGHLAND AVE
Practice Address - Street 2:UNIT D
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-5552
Practice Address - Country:US
Practice Address - Phone:310-462-6612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13877225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation