Individual
JESSE WILCOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
218 W WHITE MOUNTAIN BLVD, SUITE A & B, LAKESIDE, AZ 85929-7013
(928) 367-5779
(928) 367-5778
Mailing address
218 W WHITE MOUNTAIN BLVD, SUITE A & B, LAKESIDE, AZ 85929-7013
(928) 367-5779
(928) 367-5778
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5751
AZ
225XM0800X
Mental Health Occupational Therapist
5751
AZ
225XP0019X
Physical Rehabilitation Occupational Therapist
5751
AZ
225XP0200X
Pediatric Occupational Therapist
5751
AZ
Other
Enumeration date
04/15/2014
Last updated
04/15/2014
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