Provider Demographics
NPI:1598443434
Name:WILSON, EMILY ANN (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8340 MISSION RD STE B
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66206-1355
Mailing Address - Country:US
Mailing Address - Phone:913-213-3531
Mailing Address - Fax:
Practice Address - Street 1:8340 MISSION RD STE B
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66206-1355
Practice Address - Country:US
Practice Address - Phone:913-213-3531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-06003225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist