Individual
MISS JESSICA MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
217 TORO RD, HARTFORD, AL 36344-1459
(334) 588-3542
Mailing address
104 WAVERLY PL, ENTERPRISE, AL 36330-8626
(334) 301-0196
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4190
AL
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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