Individual
TYLER RAY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
900 E AIRPORT RD, OKMULGEE, OK 74447-9082
(918) 260-4613
Mailing address
1116 S XANTHUS PL, TULSA, OK 74104-3812
(918) 260-4613
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5687
OK
Other
Enumeration date
07/26/2022
Last updated
07/26/2022
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