Individual
TERRY ROGER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Contact information
Practice address
920 OLIVER RD, MONROE, LA 71201-5702
(318) 812-7559
(318) 812-7563
Mailing address
130 DESIARD ST, SUITE 355, MONROE, LA 71201-7319
(318) 807-7875
(318) 812-6603
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OTT.Z11857
LA
363A00000X
Physician Assistant
Primary
200134
LA
Other
Enumeration date
05/08/2006
Last updated
06/13/2019
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