=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902283583
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOY DENISE WILCOCK OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2015
-----------------------------------------------------
Last Update Date | 05/02/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2556 X4 RD
-----------------------------------------------------
City | SABETHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66534-9479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-284-0460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2556 X4 RD
-----------------------------------------------------
City | SABETHA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66534-9479
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 785-284-0460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 442
-----------------------------------------------------
License Number State | NE
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 17-01035
-----------------------------------------------------
License Number State | KS
-----------------------------------------------------