Provider Demographics
NPI:1356584338
Name:WILSON, CLARA MARIE (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:CLARA
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MISS
Other - First Name:CLARA
Other - Middle Name:MARIE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:214 HARTMAN PL
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-2464
Mailing Address - Country:US
Mailing Address - Phone:636-629-9826
Mailing Address - Fax:
Practice Address - Street 1:214 HARTMAN PL
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-2464
Practice Address - Country:US
Practice Address - Phone:636-629-9826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007026768225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist