Individual
BRIAN MITCHELL WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR
Contact information
Practice address
9850 W ST LUKES DR, NAMPA, ID 83687-7912
(469) 585-5771
Mailing address
9850 W ST LUKES DR, NAMPA, ID 83687-7912
(469) 585-5771
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-2031
ID
Other
Enumeration date
11/12/2021
Last updated
11/12/2021
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