Provider Demographics
NPI:1154559540
Name:WILLSON, VICTORIA HOPE (COTA/L)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:HOPE
Last Name:WILLSON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NE
Mailing Address - Zip Code:68701-5110
Mailing Address - Country:US
Mailing Address - Phone:402-316-4717
Mailing Address - Fax:
Practice Address - Street 1:1112 15TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-5304
Practice Address - Country:US
Practice Address - Phone:402-564-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE755224Z00000X
IA00574224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant