Individual
GLADSTONE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
14855 262ND PL, ROSEDALE, NY 11422-3039
(347) 275-0492
Mailing address
14855 262ND PL, ROSEDALE, NY 11422-3039
(347) 275-0492
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
023579
NY
Other
Enumeration date
05/01/2019
Last updated
05/01/2019
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