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General NPI Number Information
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NPI Number | 1942580550
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Entity Type | Individual
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Provider Name | MARY H WILSON OT
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Gender | Female
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 4208 RETAMA CIR
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City | VICTORIA
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State | TX
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Zip | 77901-2765
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Country | US
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Telephone | 361-582-0611
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Fax | 361-582-4805
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Provider Business Mailing Address
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Address Line | 503 BROOKS RD
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City | VICTORIA
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State | TX
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Zip | 77904-1468
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Country | US
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Telephone | 361-579-8517
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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 | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 100728
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License Number State | TX
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