Provider Demographics
NPI:1902429160
Name:WILSON, JESSICA L (PT, DPT)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:WILSON
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:L
Other - Last Name:SCHOOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 721018
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-4786
Mailing Address - Country:US
Mailing Address - Phone:405-809-8713
Mailing Address - Fax:
Practice Address - Street 1:4329 S PEORIA AVE STE 320
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-3936
Practice Address - Country:US
Practice Address - Phone:918-794-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5825225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist