Provider Demographics
NPI:1386171916
Name:YVONNE WILCOX L.M.T.
Entity type:Organization
Organization Name:YVONNE WILCOX L.M.T.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:304-575-5296
Mailing Address - Street 1:144 HOTCHKISS RD
Mailing Address - Street 2:
Mailing Address - City:SLAB FORK
Mailing Address - State:WV
Mailing Address - Zip Code:25920-9505
Mailing Address - Country:US
Mailing Address - Phone:304-575-5296
Mailing Address - Fax:
Practice Address - Street 1:129 MAIN ST STE 203
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4615
Practice Address - Country:US
Practice Address - Phone:304-575-5296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1999-0234225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1275817488OtherGROUP