Provider Demographics
NPI:1841773454
Name:WILCOX, JULIE ANN (OTR/L)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:WILCOX
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6915 MANOR CREST DR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-9296
Mailing Address - Country:US
Mailing Address - Phone:501-472-8503
Mailing Address - Fax:
Practice Address - Street 1:2107 DUDLEY ST
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:AR
Practice Address - Zip Code:71854-6345
Practice Address - Country:US
Practice Address - Phone:870-772-4427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AROTR2018225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist