Individual
CHARLENE B WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2925 WEBB RD, MILTON, GA 30004-4483
(347) 551-6057
Mailing address
2925 WEBB RD, MILTON, GA 30004-4483
(347) 551-6057
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA002590
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
061605834
GEORGIA DRIVERS LICENSE
GA
05
—
061605834
—
GA
Enumeration date
06/21/2022
Last updated
06/21/2022
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