Provider Demographics
NPI:1316780570
Name:WILSON, HEATHER MARIE (OTR/L)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:MARIE
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WEESON RD
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5124
Mailing Address - Country:US
Mailing Address - Phone:972-974-8531
Mailing Address - Fax:
Practice Address - Street 1:1000 WEESON RD
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-5124
Practice Address - Country:US
Practice Address - Phone:972-974-8531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113492225XE0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XE0001XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistEnvironmental ModificationGroup - Multi-Specialty