Healthcare Provider Details

I. General information

NPI: 1023245263
Provider Name (Legal Business Name): EMILY ELAINE WILSON MA, BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EMILY ELAINE ANDERSON

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

560 SHERIDAN ST
ASHLAND OR
97520-1572
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone: 206-604-1476
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number27487
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: