Healthcare Provider Details

I. General information

NPI: 1376476010
Provider Name (Legal Business Name): ASHLEY GRACE WILCOX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1184 MYSTIC WAY
WELLINGTON FL
33414-5612
US

IV. Provider business mailing address

17826 NW 254TH ST
OKEECHOBEE FL
34972-4735
US

V. Phone/Fax

Practice location:
  • Phone: 561-502-9881
  • Fax:
Mailing address:
  • Phone: 561-502-9881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-501529
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: