Provider Demographics
NPI:1487907465
Name:WILCOX, SARA
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:
Last Name:WILCOX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 DA VINCI DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60140-5602
Mailing Address - Country:US
Mailing Address - Phone:847-443-4326
Mailing Address - Fax:847-443-4326
Practice Address - Street 1:696 DA VINCI DR
Practice Address - Street 2:
Practice Address - City:HAMPSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60140-5602
Practice Address - Country:US
Practice Address - Phone:847-443-4326
Practice Address - Fax:847-443-4326
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist