Basic Information
| Provider Information | |||||||||
| NPI: | 1932763562 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | COX | ||||||||
| FirstName: | MAKINZE | ||||||||
| MiddleName: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30940 FOUR CORNER RD | ||||||||
| Address2: | |||||||||
| City: | PALMYRA | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626744506 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2174165929 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 UNIVERSITY ST | ||||||||
| Address2: | |||||||||
| City: | CARLINVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 626269600 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2178544433 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2019 | ||||||||
| LastUpdateDate: | 04/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 224Z00000X | 057.005161 | IL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant |
No ID Information.