Individual
JENNIFER LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTAL
Contact information
Practice address
700 MT HOPE AVE, SUITE 320, BANGOR, ME 04401-5680
(207) 941-2952
(207) 941-2955
Mailing address
1048 UNION ST, SUITE 5, BANGOR, ME 04401
(207) 945-5247
(207) 947-0435
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OA1514
ME
Other
Enumeration date
06/04/2007
Last updated
01/09/2008
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