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Individual

MRS. CAROL LYLE WILSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
5101 MEDICAL DR, SAN ANTONIO, TX 78229-4801
(210) 616-0100
(210) 592-5491
Mailing address
13603 LYTLE LN, HELOTES, TX 78023-2978
(210) 695-1446

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
209034
TX

Other

Enumeration date
03/31/2008
Last updated
03/31/2008
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