Provider Demographics
NPI:1255075222
Name:WILSON, ABIGAIL M (MS, OTR/L)
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:M
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 TIMBER TRL
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2163
Mailing Address - Country:US
Mailing Address - Phone:330-410-5722
Mailing Address - Fax:
Practice Address - Street 1:224 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2163
Practice Address - Country:US
Practice Address - Phone:330-410-5722
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-25
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT009847225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist