Individual
KELE ELIZABETH WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1500 WILSON LOOP ROAD, WARD, AR 72176
(501) 941-5630
(501) 843-2270
Mailing address
P.O. BOX 333, WARD, AR 72176
(501) 941-5630
(501) 843-2270
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTR772
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
129951721
—
AR
Enumeration date
08/06/2009
Last updated
08/06/2009
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