Individual
KENNA LEANN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOT, OTR/L
Contact information
Practice address
801 N 11TH ST, SAINT LOUIS, MO 63101-1015
(314) 633-5300
Mailing address
124 COUNTRY CLUB PARC CT, IMPERIAL, MO 63052-3626
(573) 718-9888
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
2021017558
MO
225XP0200X
Pediatric Occupational Therapist
Primary
2021017558
MO
Other
Enumeration date
05/25/2021
Last updated
06/11/2026
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