Provider Demographics
NPI:1588842728
Name:WILLCOX, KEVIN WOODD (LMP, NCSA-CPT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:WOODD
Last Name:WILLCOX
Suffix:
Gender:M
Credentials:LMP, NCSA-CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1107 OAK ST
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:WA
Mailing Address - Zip Code:98354-9234
Mailing Address - Country:US
Mailing Address - Phone:253-896-1212
Mailing Address - Fax:253-474-7980
Practice Address - Street 1:1107 OAK ST
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:WA
Practice Address - Zip Code:98354-9234
Practice Address - Country:US
Practice Address - Phone:253-896-1212
Practice Address - Fax:253-474-7980
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021916174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist