Individual
LISA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14673 MIDWAY RD STE 1-111, ADDISON, TX 75001-3171
(972) 851-1022
Mailing address
10341 SHADOW VALLEY CT, BURLESON, TX 76028-0181
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
217536
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4696826774
—
TX
Enumeration date
08/15/2022
Last updated
08/15/2022
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