Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | ||
Y | 225XL0004X | Low Vision | 112297 | TX |
N | 225XN1300X | Occupational Therapist - Neurorehabilitation |
NPI | 1598163511 |
---|---|
Provider Name | Staci Tibbs Wilson |
First Address | Pearland, TX 77584-7283 |
Second Address | Pearland, TX 77584-3476 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2014 |
Last Update Date | 04/02/2022 |