Provider Demographics
NPI:1558661421
Name:COX, JILL MEGAN (COTA)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:MEGAN
Last Name:COX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1105 DAVIDSON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-6606
Mailing Address - Country:US
Mailing Address - Phone:262-784-4740
Mailing Address - Fax:262-784-4776
Practice Address - Street 1:1105 DAVIDSON RD
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-6606
Practice Address - Country:US
Practice Address - Phone:262-784-4740
Practice Address - Fax:262-784-4776
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4686-027224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant