Individual
LAURA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C-OTA
Contact information
Practice address
2035 W ILES AVE, STE C, SPRINGFIELD, IL 62704-4192
(800) 773-1682
(309) 713-2898
Mailing address
97 EASTGATE DR, WASHINGTON, IL 61571-9271
(800) 773-1682
(309) 713-2898
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004529
IL
Other
Enumeration date
06/30/2016
Last updated
06/30/2016
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