Individual
JACQUELINE SUE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P. T.
Contact information
Practice address
901 N PORTER AVE, NORMAN, OK 73071-6404
(405) 307-1712
(405) 307-1716
Mailing address
2201 SW 136TH PL, OKLAHOMA CITY, OK 73170-5732
(405) 205-5807
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
997
OK
Other
Enumeration date
10/27/2016
Last updated
10/27/2016
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