MEDICARE: MRS. KARLY WILCOX OTR/L

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
1	225X00000X	Occupational Therapist	OTR2912	AR

General Provider Information

NPI Number	:	1861844052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARLY WILCOX OTR/L

Provider Business Mailing Address
First Line	:	PO BOX 952
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-0952
Country	:	US
Telephone Number	:	501-365-3927
Fax Number	:	501-365-3914

Provider Business Practice Location Address
First Line	:	1008 HIGHWAY 25B
Second Line	:
City	:	HEBER SPRINGS
State	:	AR
Zip	:	72543-2034
Country	:	US
Telephone Number	:	501-365-3927
Fax Number	:	501-365-3914

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2016
Last Update Date	:	08/16/2018

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