Provider Demographics
NPI:1124521869
Name:WILSON, KARRY LYNN (MOTR/L)
Entity type:Individual
Prefix:
First Name:KARRY
Middle Name:LYNN
Last Name:WILSON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:KARRY
Other - Middle Name:LYNN
Other - Last Name:ADAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L
Mailing Address - Street 1:13904 BARNES RD
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MI
Mailing Address - Zip Code:48418-9773
Mailing Address - Country:US
Mailing Address - Phone:810-730-7795
Mailing Address - Fax:
Practice Address - Street 1:275 CALEDONIA DRIVE
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867
Practice Address - Country:US
Practice Address - Phone:989-743-3491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI225XG0600X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology