Provider Demographics
NPI:1134365240
Name:WILCOX, STACY M (OT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:M
Last Name:WILCOX
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FERNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SIMSBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06070-2902
Mailing Address - Country:US
Mailing Address - Phone:860-940-2413
Mailing Address - Fax:860-854-2717
Practice Address - Street 1:20 AVON MEADOW LN STE 220
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3731
Practice Address - Country:US
Practice Address - Phone:860-940-2413
Practice Address - Fax:860-854-2717
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003498225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist