Individual
KRISTINE MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
6458 CITY WEST PKWY, EDEN PRAIRIE, MN 55344-3245
(612) 767-7222
Mailing address
6458 CITY WEST PKWY, EDEN PRAIRIE, MN 55344-3245
(612) 767-7222
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
201405
MN
225X00000X
Occupational Therapist
Primary
104701
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
104701
OT LICENSURE
MN
01
—
201405
MN LICENSURE
MN
Enumeration date
05/10/2007
Last updated
04/10/2015
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