Provider Demographics
NPI:1861955189
Name:ALLCOX, JENNIFER G (COTA)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:ALLCOX
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N32W6883 PALMETTO CT
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2208
Mailing Address - Country:US
Mailing Address - Phone:262-327-8224
Mailing Address - Fax:
Practice Address - Street 1:7800 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:RIVER HILLS
Practice Address - State:WI
Practice Address - Zip Code:53217-2047
Practice Address - Country:US
Practice Address - Phone:414-858-6256
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5583-27224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant