Provider Demographics
NPI:1457456758
Name:WILKERSON, PEGGY ANN (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:ANN
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
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Mailing Address - Street 1:412 LEMONT ST
Mailing Address - Street 2:N/A
Mailing Address - City:LEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60439-4027
Mailing Address - Country:US
Mailing Address - Phone:630-257-2425
Mailing Address - Fax:630-257-2420
Practice Address - Street 1:303 QUADRANGLE DRIVE
Practice Address - Street 2:N/A
Practice Address - City:BOLINGBROOK
Practice Address - State:IL
Practice Address - Zip Code:60440
Practice Address - Country:US
Practice Address - Phone:630-771-1070
Practice Address - Fax:630-771-1030
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant