Provider Demographics
NPI:1245828656
Name:WILSON, ALYRIA (MOT)
Entity type:Individual
Prefix:MRS
First Name:ALYRIA
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:ALYRIA
Other - Middle Name:
Other - Last Name:COLAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 373
Mailing Address - Street 2:
Mailing Address - City:BROUSSARD
Mailing Address - State:LA
Mailing Address - Zip Code:70518-0373
Mailing Address - Country:US
Mailing Address - Phone:337-578-2562
Mailing Address - Fax:
Practice Address - Street 1:138 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-3725
Practice Address - Country:US
Practice Address - Phone:337-578-2562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-02
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty