Healthcare Provider Details

I. General information

NPI: 1558613174
Provider Name (Legal Business Name): ANITA MARIE FOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 W WALNUT ST
JACKSONVILLE IL
62650-1136
US

IV. Provider business mailing address

1103 MASON LN
WINCHESTER IL
62694-3675
US

V. Phone/Fax

Practice location:
  • Phone: 217-245-9541
  • Fax: 217-479-5675
Mailing address:
  • Phone: 217-248-3989
  • Fax: 217-616-3163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056006007
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: