Provider Demographics
NPI:1114951654
Name:WILSON, EMILY C (OT)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:C
Last Name:WILSON
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-4705
Mailing Address - Country:US
Mailing Address - Phone:940-696-0292
Mailing Address - Fax:
Practice Address - Street 1:1921 9TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-4129
Practice Address - Country:US
Practice Address - Phone:940-687-3422
Practice Address - Fax:940-687-0726
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101247174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist