Provider Demographics
NPI:1134339096
Name:WILSON, NAKII VALEETA (OTR)
Entity type:Individual
Prefix:
First Name:NAKII
Middle Name:VALEETA
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8026 S ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60620-3826
Mailing Address - Country:US
Mailing Address - Phone:773-723-6545
Mailing Address - Fax:773-723-6545
Practice Address - Street 1:8026 S ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60620-3826
Practice Address - Country:US
Practice Address - Phone:773-723-6545
Practice Address - Fax:773-723-6545
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056007037225X00000X
IL056.007037225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist