Individual
MRS. NICOLE CLAIRE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
2508 GUNPOWDER RD, LITTLE ROCK, AR 72227-3029
(520) 240-3723
Mailing address
2508 GUNPOWDER RD, LITTLE ROCK, AR 72227-3029
(520) 240-3723
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
5669
AZ
224Z00000X
Occupational Therapy Assistant
Primary
OT-A962
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207699721
—
AR
Enumeration date
12/09/2014
Last updated
11/16/2021
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