Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | 13877 | CA |
NPI | 1285039560 |
---|---|
Provider Name | Dr. Jamieson Wilcox |
First Address | Manhattan Beach, CA 90266-5552 |
Second Address | Manhattan Beach, CA 90266-5552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/10/2014 |
Last Update Date | 28/10/2014 |