Individual
DOMINIQUE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
14906 JEFFERSON DAVIS HWY, WOODBRIDGE, VA 22191-4016
(703) 491-6167
Mailing address
8191 STRAWBERRY LN APT 103, FALLS CHURCH, VA 22042-1043
(908) 938-6206
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119-008493
VA
Other
Enumeration date
04/04/2020
Last updated
04/04/2020
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