Individual
MRS. SHANNON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
45 N STATION PLZ, GREAT NECK, NY 11021-5033
(516) 482-2650
Mailing address
121 PINEWOOD RD, MANHASSET, NY 11030-1517
(516) 627-1663
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
009992
NY
Other
Enumeration date
09/13/2016
Last updated
09/13/2016
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