Individual
KIRSTEN CORINNE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
717 E ALFRED ST, WEYAUWEGA, WI 54983-9024
(920) 867-3121
Mailing address
8789 EDGEWATER RDG, OMRO, WI 54963-9800
(920) 685-6121
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
991-027
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40760700
—
WI
Enumeration date
05/04/2007
Last updated
07/08/2007
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