Provider Demographics
NPI:1467969030
Name:WILCOX, JESSICA LOIS (OTR)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LOIS
Last Name:WILCOX
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 VINING PL
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-4201
Mailing Address - Country:US
Mailing Address - Phone:207-522-0210
Mailing Address - Fax:
Practice Address - Street 1:348 W KING TUT RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9652
Practice Address - Country:US
Practice Address - Phone:207-522-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-04
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
388889225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist