Mary Elizabeth Miller Willson, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT005159 Issued in GA

Practice address

1120 15TH St
Augusta, GA 30912-2865

Phone

(706) 721-2273

NPI assigned

Jun 7, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Sensational Kids Pediatric Rehabilitation & Counseling, Inc.

  • Clinic/Center
  • Martinez, GA
  • NPI 1962676502
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551657600000",
    "number": "1013201037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3485 GREENWAY DR",
            "city": "EVANS",
            "state": "GA",
            "postal_code": "308094276",
            "telephone_number": "912-657-0140"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 15TH ST",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309122865",
            "telephone_number": "706-721-2273"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3624 Old Petersburg Rd",
            "address_purpose": "LOCATION",
            "city": "Augusta",
            "state": "GA",
            "postal_code": "309072865",
            "country_code": "US",
            "telephone_number": "706-364-3470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLSON",
        "first_name": "MARY",
        "middle_name": "ELIZABETH MILLER",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-06-07",
        "last_updated": "2019-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT005159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connie Rae Willis, R.D.
• Lauren Willis, PHD, PHARMD
• Samuel Andersen Willis, M.D.
• Stacy L Willis, BS
• Edward Terrell Wills, D.O.
• Alicia Wilson
• Barbara Harper Wilson
• Brandy Carol Wilson
• Carter Wilson, RN
• Chelsey Tonitte Marie Wilson

• Occupational Therapist in Augusta, GA
• Providers in Augusta, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.