MEDICARE: CHRISTINA WILCOX OT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	2814	SC

General Provider Information

NPI Number	:	1588789374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA WILCOX OT

Provider Business Mailing Address
First Line	:	2222 SULLIVAN TRL
Second Line	:
City	:	EASTON
State	:	PA
Zip	:	18040-7958
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	320 SEVEN FARMS DR
Second Line	:
City	:	DANIEL ISLAND
State	:	SC
Zip	:	29492-7532
Country	:	US
Telephone Number	:	843-884-4192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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