Provider Demographics
NPI:1992792949
Name:WILSON, RICHARD (OT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:WILSON
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3311 TOLEDO TERRACE
Mailing Address - Street 2:A-1
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20782
Mailing Address - Country:US
Mailing Address - Phone:301-853-0093
Mailing Address - Fax:301-853-0096
Practice Address - Street 1:3311 TOLEDO TERRACE
Practice Address - Street 2:A-1
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782
Practice Address - Country:US
Practice Address - Phone:301-853-0093
Practice Address - Fax:301-853-0096
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02297225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist