Individual
MRS. KELLY ELIZABETH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1522 MORRIS AVE, NORFOLK, VA 23509-1217
(248) 342-3180
Mailing address
1522 MORRIS AVE, NORFOLK, VA 23509-1217
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005041
VA
Other
Enumeration date
12/24/2009
Last updated
12/24/2009
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