Provider Demographics
NPI:1790101236
Name:WILSON, JANICE P (OTR/L)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:P
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:JANICE
Other - Middle Name:SUSAN
Other - Last Name:PETERSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:8 HOCKANUM RD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2531
Mailing Address - Country:US
Mailing Address - Phone:413-341-3859
Mailing Address - Fax:
Practice Address - Street 1:8 HOCKANUM RD
Practice Address - Street 2:UNIT 1
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2531
Practice Address - Country:US
Practice Address - Phone:413-341-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11120225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist