Individual
OTAVIA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1321 PARK BAYOU DR, HOUSTON, TX 77077-1507
(833) 539-1367
Mailing address
19806 CAMPFIELD DR, KATY, TX 77449-6693
(281) 758-9302
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2173256
TX
Other
Enumeration date
11/21/2022
Last updated
11/21/2022
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