Provider Demographics
NPI:1548676406
Name:WILCOX, KATHRYN
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5970 CARVEL AVE
Mailing Address - Street 2:APT E
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2678
Mailing Address - Country:US
Mailing Address - Phone:317-405-9016
Mailing Address - Fax:888-654-4116
Practice Address - Street 1:5970 CARVEL AVE
Practice Address - Street 2:APT E
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2678
Practice Address - Country:US
Practice Address - Phone:317-405-9016
Practice Address - Fax:888-654-4116
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN31005634A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN31005634AOtherINDIANA OCCUPATIONAL LICENSE