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NPI Code Detail

MEDICARE: MARION DIANE WILCOCK

MEDICARE: MARION DIANE WILCOCK
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
1106S00000XBehavior TechnicianRBT-17-36147CO

General Provider Information

NPI Number : 1154837235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARION DIANE WILCOCK
Provider Business Mailing Address
First Line : 5225 NORTON RD
Second Line :
City : GROVE CITY
State : OH
Zip : 43123-9664
Country : US
Telephone Number : 614-668-3277
Fax Number : 419-747-4126
Provider Business Practice Location Address
First Line : 3042 MCKINLEY AVE
Second Line :
City : COLUMBUS
State : OH
Zip : 43204-3653
Country : US
Telephone Number : 614-487-7805
Fax Number : 419-747-4126
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2017
Last Update Date : 12/27/2017

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Directions to “ MARION DIANE WILCOCK ” Practice Location

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