Healthcare Provider Details

I. General information

NPI: 1124521869
Provider Name (Legal Business Name): KARRY LYNN WILSON MOTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KARRY LYNN ADAMS MOTR/L

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 03/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 CALEDONIA DRIVE
OWOSSO MI
48867
US

IV. Provider business mailing address

13904 BARNES RD
BYRON MI
48418-9773
US

V. Phone/Fax

Practice location:
  • Phone: 989-743-3491
  • Fax:
Mailing address:
  • Phone: 810-730-7795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code225XG0600X
TaxonomyGerontology Occupational Therapist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: