Provider Demographics
NPI:1972823326
Name:WILKERSON, WESLEY D (PTA, OTR/L)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:D
Last Name:WILKERSON
Suffix:
Gender:M
Credentials:PTA, 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:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:PEA RIDGE
Mailing Address - State:AR
Mailing Address - Zip Code:72751-0585
Mailing Address - Country:US
Mailing Address - Phone:479-451-9434
Mailing Address - Fax:479-488-6220
Practice Address - Street 1:827 SLACK ST
Practice Address - Street 2:
Practice Address - City:PEA RIDGE
Practice Address - State:AR
Practice Address - Zip Code:72751-3703
Practice Address - Country:US
Practice Address - Phone:479-451-9434
Practice Address - Fax:479-488-6220
Is Sole Proprietor?:No
Enumeration Date:2010-06-08
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 2414208100000X
AROTR2768225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation