Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 224Z00000X | Occupational Therapy Assistant | 210558 | TX |
Y | 224Z00000X | Occupational Therapy Assistant | OT-A563 | AR |
NPI | 1023344777 |
---|---|
Provider Name | Mrs. Whitney Osborne Wilson |
First Address | Bloomburg, TX 75556-1982 |
Second Address | Texarkana, AR 71854-9036 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2009 |
Last Update Date | 29/10/2009 |