Individual
JONATHAN TYLER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
711 FRANKFORT RD, SHELBYVILLE, KY 40065-9447
(502) 633-3486
Mailing address
1011 CHINOE RD, LEXINGTON, KY 40502-3009
(859) 585-8925
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
246681
KY
Other
Enumeration date
12/02/2019
Last updated
12/02/2019
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