Individual
AMIE L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
402 FIRST ST, RANDOM LAKE, WI 53075-0323
(920) 994-9700
Mailing address
W7533 CHERRY HILL DR, ADELL, WI 53001-1294
(920) 994-9495
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3556-26
WI
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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