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General NPI Number Information
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NPI Number | 1841039500
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Entity Type | Individual
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Provider Name | CALEB BRYANT WILSON
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Gender | Male
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Dates
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Enumeration Date | 05/22/2024
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Last Update Date | 05/22/2024
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Provider Practice Location Address
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Address Line | 3515 BROADWAY AVE
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City | YANKTON
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State | SD
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Zip | 57078-4917
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Country | US
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Telephone | 605-668-3100
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Fax |
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Provider Business Mailing Address
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Address Line | 26255 429TH AVE
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City | EMERY
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State | SD
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Zip | 57332-7000
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Country | US
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Telephone | 605-951-3759
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number |
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License Number State |
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