Healthcare Provider Details

I. General information

NPI: 1770724304
Provider Name (Legal Business Name): BRIDGET ANN WILSON OTR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2009
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 INDUSTRIAL DR
FENNIMORE WI
53809-9578
US

IV. Provider business mailing address

1300 N WATER ST
PLATTEVILLE WI
53818-1452
US

V. Phone/Fax

Practice location:
  • Phone: 608-822-3276
  • Fax:
Mailing address:
  • Phone: 608-348-2453
  • Fax: 608-348-2944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number1548-026
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: