Provider Demographics
NPI:1194081356
Name:WILSON, KATEE MARY (COTA, LMT)
Entity type:Individual
Prefix:
First Name:KATEE
Middle Name:MARY
Last Name:WILSON
Suffix:
Gender:F
Credentials:COTA, LMT
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:MARY
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:COTA, LMT
Mailing Address - Street 1:1662 POST RD UNIT A3
Mailing Address - Street 2:
Mailing Address - City:WELLS
Mailing Address - State:ME
Mailing Address - Zip Code:04090-4638
Mailing Address - Country:US
Mailing Address - Phone:207-730-0539
Mailing Address - Fax:
Practice Address - Street 1:1662 POST RD UNIT A3
Practice Address - Street 2:
Practice Address - City:WELLS
Practice Address - State:ME
Practice Address - Zip Code:04090-4638
Practice Address - Country:US
Practice Address - Phone:207-730-0539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3506224Z00000X
MEMT1271225700000X
NY007365-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist