Individual
MRS. AMANDA LEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
111 DEAN AVE, O FALLON, IL 62269-1614
(580) 763-7396
Mailing address
111 DEAN AVE, O FALLON, IL 62269-1614
(580) 763-7396
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2013003175
MO
Other
Enumeration date
10/06/2014
Last updated
10/06/2014
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