Provider Demographics
NPI:1417228628
Name:WILCOX, ANGELIQUE MARIE (OTR/L, OTD)
Entity Type:Individual
Prefix:MRS
First Name:ANGELIQUE
Middle Name:MARIE
Last Name:WILCOX
Suffix:
Gender:F
Credentials:OTR/L, OTD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1489 NICHOLS DR APT B
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37042-1894
Mailing Address - Country:US
Mailing Address - Phone:419-306-7355
Mailing Address - Fax:
Practice Address - Street 1:895 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:TN
Practice Address - Zip Code:37185-1018
Practice Address - Country:US
Practice Address - Phone:931-296-7552
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-19
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4488225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist