Individual
STACI TIBBS WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR, MOT, CHES
Contact information
Practice address
13212 LONE CREEK LN, PEARLAND, TX 77584-3476
(713) 280-3663
(855) 710-7269
Mailing address
11601 SHADOW CREEK PKWY STE 111-216, PEARLAND, TX 77584-7283
(713) 280-3663
(855) 710-7269
Taxonomy
Speciality
Code
Description
License number
State
225XG0600X
Gerontology Occupational Therapist
—
—
225XL0004X
Low Vision Occupational Therapist
Primary
112297
TX
225XN1300X
Neurorehabilitation Occupational Therapist
—
—
Other
Enumeration date
12/08/2014
Last updated
02/04/2022
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