Individual
MISSEY RENEE' WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
209 W LUBBOCK ST, STREETMAN, TX 75859-8120
(903) 229-7139
Mailing address
209 W LUBBOCK ST, STREETMAN, TX 75859-8120
(903) 229-7139
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
211024
TX
Other
Enumeration date
04/12/2022
Last updated
04/12/2022
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