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NPI Code Detail

MEDICARE: GRETCHEN ANN WILSON MSOTRL

MEDICARE:   GRETCHEN ANN WILSON  MSOTRL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist2100NM

General Provider Information

NPI Number : 1013061506
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRETCHEN ANN WILSON MSOTRL
Provider Business Mailing Address
First Line : 7019 CLARK HILLS DR NE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87144-8677
Country : US
Telephone Number : 505-401-4235
Fax Number :
Provider Business Practice Location Address
First Line : 2400 UNSER BLVD SE
Second Line :
City : RIO RANCHO
State : NM
Zip : 87124-3392
Country : US
Telephone Number : 505-401-4235
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/22/2007
Last Update Date : 12/30/2011

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Directions to “ GRETCHEN ANN WILSON MSOTRL” Practice Location

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