Provider Demographics
NPI:1356534499
Name:WILSON, KAREN T (PT, OCS)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:T
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:C
Other - Last Name:BRAGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:112 SANFORD RD
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-5533
Mailing Address - Country:US
Mailing Address - Phone:207-646-0373
Mailing Address - Fax:207-646-0381
Practice Address - Street 1:112 SANFORD RD
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-5533
Practice Address - Country:US
Practice Address - Phone:207-646-0373
Practice Address - Fax:207-646-0381
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME689225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist