Active NPI
Maxwell Wilson
- Occupational Therapist
- Longview, WA
National Provider Identifier
1417819848
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 61642856
- Practice address
- 200 Triangle Center #270
Longview, WA 98632-2367 - Phone
- (360) 501-3750
- Fax
- (360) 501-3755
- NPI assigned
- Nov 24, 2025
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 61642856 | WA | Primary |
Addresses
Primary practice location
200 Triangle Center #270
Longview, WA 98632-2367
Mailing address
1615 Delaware St
Longview, WA 98632-2367
Phone (360) 414-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Occupational Therapist in Private Practice
- Education
- Other, 2024
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
12914 NE 37TH St
Vancouver, WA 98682-7626
200 Triangle Ctr
Suite 270
Longview, WA 98632
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 61642856 | WA | MD | Occupational Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peacehealth | Current | Accepting new patients | |
| Peacehealth | Occupational Therapist | Past | Accepting new patients |
Locations
1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818
Organizations & group practices 2
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.
-
- Multi-Specialty Clinic/Center
- Longview, WA
- NPI 1720056187
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763942400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769126400000",
"number": "1417819848",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1615 DELAWARE ST",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322367",
"telephone_number": "360-414-2000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 TRIANGLE CENTER #270",
"city": "LONGVIEW",
"state": "WA",
"postal_code": "986322367",
"telephone_number": "360-501-3750",
"fax_number": "360-501-3755"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "MAXWELL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-11-24",
"last_updated": "2026-01-23",
"certification_date": "2026-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "WA",
"license": "61642856",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longview, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.