Individual
JAMES WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3903 WHIRLWIND ST, BRYANT, AR 72022-6710
(479) 967-2322
Mailing address
3903 WHIRLWIND ST, BRYANT, AR 72022-6710
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A924
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207046721
—
AR
Enumeration date
04/22/2015
Last updated
04/22/2015
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