Provider Demographics
NPI:1356076582
Name:WILCOX, LOCO (RRT)
Entity Type:Individual
Prefix:MRS
First Name:LOCO
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:RRT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6881 COUNTY PLACE DR
Mailing Address - Street 2:
Mailing Address - City:HOPE MILLS
Mailing Address - State:NC
Mailing Address - Zip Code:28348-7856
Mailing Address - Country:US
Mailing Address - Phone:910-308-6101
Mailing Address - Fax:
Practice Address - Street 1:6881 COUNTY PLACE DR
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7856
Practice Address - Country:US
Practice Address - Phone:910-308-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-21
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10005227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1477079663Medicaid