Individual
AUDREY WILSON- ALSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
506 BROOKSONG CT, IRMO, SC 29063-6100
(803) 200-6328
Mailing address
506 BROOKSONG CT, IRMO, SC 29063-6100
(803) 200-6328
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
476
SC
Other
Enumeration date
10/27/2022
Last updated
10/27/2022
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