Healthcare Provider Details

I. General information

NPI: 1346152501
Provider Name (Legal Business Name): TAMMY WILCOXEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50260 HARVEST LN
RACINE OH
45771-7527
US

IV. Provider business mailing address

50260 HARVEST LN
RACINE OH
45771-7527
US

V. Phone/Fax

Practice location:
  • Phone: 740-361-6803
  • Fax:
Mailing address:
  • Phone: 740-361-6803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146D00000X
TaxonomyPersonal Emergency Response Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: