Provider Demographics
NPI:1346889359
Name:WILSON, RYAN (OT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
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 1:8320 5TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4174
Mailing Address - Country:US
Mailing Address - Phone:206-650-8653
Mailing Address - Fax:
Practice Address - Street 1:8320 5TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4174
Practice Address - Country:US
Practice Address - Phone:206-650-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60662045225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist