Provider Demographics
NPI:1356528467
Name:WILSON, JANE LEWIS (OTR/L)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:LEWIS
Last Name:WILSON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:63 MARSHALL PL
Mailing Address - Street 2:
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2320
Mailing Address - Country:US
Mailing Address - Phone:314-963-7505
Mailing Address - Fax:314-961-7033
Practice Address - Street 1:7733 FORSYTH BLVD
Practice Address - Street 2:SUITE 2300
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-1817
Practice Address - Country:US
Practice Address - Phone:314-863-7422
Practice Address - Fax:314-645-8271
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000630225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist