Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC009496 | PA |
NPI | 1275847055 |
---|---|
Provider Name | Mrs. Lori Jean Wilson |
First Address | Hughesville, PA 17737-0032 |
Second Address | Northumberland, PA 17857-0032 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/08/2010 |
Last Update Date | 04/08/2010 |