Provider Demographics
NPI:1134514664
Name:WILSON-CAHOON, CRISSY (COTA)
Entity Type:Individual
Prefix:
First Name:CRISSY
Middle Name:
Last Name:WILSON-CAHOON
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FARM LN
Mailing Address - Street 2:P.O. BOX 1983
Mailing Address - City:SEABROOK
Mailing Address - State:NH
Mailing Address - Zip Code:03874-4207
Mailing Address - Country:US
Mailing Address - Phone:603-474-5098
Mailing Address - Fax:
Practice Address - Street 1:15 KIRKBRIDE DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-6011
Practice Address - Country:US
Practice Address - Phone:978-716-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3488224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant