Provider Demographics
NPI:1043403629
Name:WILSON, CHAD E (OT)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:E
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 1:9337 MIAMI BLUFF DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5534
Mailing Address - Country:US
Mailing Address - Phone:520-661-2614
Mailing Address - Fax:
Practice Address - Street 1:101 E WT HARRIS BLVD STE 5001
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-3574
Practice Address - Country:US
Practice Address - Phone:704-583-5763
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3780225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist