Individual
MS. JAN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ROT
Contact information
Practice address
555 E CLAY ST, EL PASO, IL 61738-1508
(309) 527-6240
Mailing address
1702 LONGDEN AVE, BLOOMINGTON, IL 61701-8304
(309) 527-6240
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
IL
Other
Enumeration date
03/27/2007
Last updated
07/08/2007
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