Individual
MS. REBECCA R WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
107 WILLOWCREST DR, ELBRIDGE, NY 13060-9717
(315) 689-0017
Mailing address
107 WILLOWCREST DR, ELBRIDGE, NY 13060-9717
(315) 689-0017
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
007117
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
007117
NYS
NY
Enumeration date
07/03/2008
Last updated
07/03/2008
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