Individual
COLLEEN ELIZABETH WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
913 NW GARDEN VALLEY BLVD, ROSEBURG, OR 97471-6523
(541) 440-1000
Mailing address
4885 ASTER ST APT 90, SPRINGFIELD, OR 97478-6899
(425) 953-3399
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
80107
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
80107
NATIONAL COUNCIL FOR THERAPEUTIC RECREATION CERTIFICATION
—
Enumeration date
04/16/2021
Last updated
04/16/2021
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