Individual
MAELLEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
Mailing address
781 GRAND CASINO BLVD, SHAWNEE, OK 74804-1005
(405) 964-5770
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
6826
OK
Other
Enumeration date
03/10/2026
Last updated
03/10/2026
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