Individual
STEPHEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5195 BUYSERIE RD NE, SAINT PAUL, OR 97137-9707
(971) 267-2127
Mailing address
5195 BUYSERIE RD NE, SAINT PAUL, OR 97137-9707
(971) 267-2127
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
349598
OR
Other
Enumeration date
06/21/2016
Last updated
06/21/2016
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