Provider Demographics
NPI:1043403629
Name:WILSON, CHAD E (OT)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:E
Last Name:WILSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12571 N GRANVILLE CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-8939
Mailing Address - Country:US
Mailing Address - Phone:520-544-0373
Mailing Address - Fax:
Practice Address - Street 1:5501 N ORACLE RD
Practice Address - Street 2:STE 101
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-3829
Practice Address - Country:US
Practice Address - Phone:520-293-5551
Practice Address - Fax:520-747-1633
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist