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NPI Code Detail

MEDICARE: KRISTEN WILCOX

MEDICARE: KRISTEN WILCOX
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
1222Q00000XDevelopmental TherapistIN

General Provider Information

NPI Number : 1497610182
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN WILCOX
Provider Business Mailing Address
First Line : 2626 SAINT JOE CENTER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5042
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2626 SAINT JOE CENTER RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-5042
Country : US
Telephone Number : 260-497-0328
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/16/2025
Last Update Date : 12/16/2025

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Directions to “ KRISTEN WILCOX ” Practice Location

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