Provider Demographics
NPI:1851635551
Name:WILSON, AUBREY L (MS,OTR/L)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:MS,OTR/L
Other - Prefix:
Other - First Name:AUBREY
Other - Middle Name:L
Other - Last Name:WHITTEMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,OTR/L
Mailing Address - Street 1:524 SCHOOL ST APT 2
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-2876
Mailing Address - Country:US
Mailing Address - Phone:207-650-5367
Mailing Address - Fax:
Practice Address - Street 1:524 SCHOOL ST APT 2
Practice Address - Street 2:
Practice Address - City:BERWICK
Practice Address - State:ME
Practice Address - Zip Code:03901-2876
Practice Address - Country:US
Practice Address - Phone:207-650-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT2770225X00000X
NH2271225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3082159Medicaid