Provider Demographics
NPI:1780183160
Name:WILKISON, MARY JESSUP (OTR/L)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JESSUP
Last Name:WILKISON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7209 CREEDMOOR RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27613-1695
Mailing Address - Country:US
Mailing Address - Phone:919-844-1100
Mailing Address - Fax:919-844-1102
Practice Address - Street 1:255 SUGAR PINE DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-9307
Practice Address - Country:US
Practice Address - Phone:910-315-6279
Practice Address - Fax:833-252-8007
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1161225X00000X
NC11611225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist