Individual
HEATHER WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1 BAKER PL, KEYSER, WV 26726-2824
(304) 788-4200
(304) 788-6461
Mailing address
552 WINIFRED RD, CUMBERLAND, MD 21502-6396
(301) 722-1460
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
591
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
03070
STATE LICENSE
MD
01
—
591
STATE LICENSE
WV
Enumeration date
04/07/2008
Last updated
04/07/2008
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