Provider Demographics
NPI:1144818766
Name:WILCOXSON, HOLLY PAIGE (ATC)
Entity type:Individual
Prefix:MISS
First Name:HOLLY
Middle Name:PAIGE
Last Name:WILCOXSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:KS
Mailing Address - Zip Code:67735-3441
Mailing Address - Country:US
Mailing Address - Phone:785-890-3641
Mailing Address - Fax:
Practice Address - Street 1:1209 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:KS
Practice Address - Zip Code:67735-3441
Practice Address - Country:US
Practice Address - Phone:785-890-3641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-013452255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer