Provider Demographics
NPI:1912731902
Name:WILCOXSON, TERENCE ANTHONY SR
Entity type:Individual
Prefix:MR
First Name:TERENCE
Middle Name:ANTHONY
Last Name:WILCOXSON
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 ILLINOIS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45410-2037
Mailing Address - Country:US
Mailing Address - Phone:937-654-5499
Mailing Address - Fax:
Practice Address - Street 1:321 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45410-2037
Practice Address - Country:US
Practice Address - Phone:937-654-5499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker