Provider Demographics
NPI:1205149101
Name:WILSON-DOWDEN, KERRI-ANN RENEE (OTRL)
Entity type:Individual
Prefix:MRS
First Name:KERRI-ANN
Middle Name:RENEE
Last Name:WILSON-DOWDEN
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 VINCENT AVE
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-1723
Mailing Address - Country:US
Mailing Address - Phone:917-855-7009
Mailing Address - Fax:
Practice Address - Street 1:368 VINCENT AVE
Practice Address - Street 2:
Practice Address - City:LYNBROOK
Practice Address - State:NY
Practice Address - Zip Code:11563-1723
Practice Address - Country:US
Practice Address - Phone:917-855-7009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-20
Last Update Date:2010-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016078-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist