Demetrius Dante Wilson, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OP003322L Issued in PA

Practice address

5485 Perkiomen Ave
Reading, PA 19606-3676

Phone

(610) 779-3993

NPI assigned

Mar 26, 2019

Sex

Male

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

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

{
    "created_epoch": "1553558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553558400000",
    "number": "1669933404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5485 PERKIOMEN AVE",
            "city": "READING",
            "state": "PA",
            "postal_code": "196063676",
            "telephone_number": "610-779-3993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5485 PERKIOMEN AVE",
            "city": "READING",
            "state": "PA",
            "postal_code": "196063676",
            "telephone_number": "610-779-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "DEMETRIUS",
        "middle_name": "DANTE",
        "name_prefix": "Mr.",
        "credential": "COTA/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-03-26",
        "last_updated": "2019-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "PA",
            "license": "OP003322L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rotimi Mafolasere Williams
• Suzanne L. Williams, COTA
• Wroway G Williams, MSW
• Earle Smith Williamson, D.O.
• Katelyn E Willis, PA
• Juanita Wilson
• David J Wimer, PH.D.
• Saturn L Wirrick
• Timothy M Wirth, M.D.
• Jackie Wise, MHS

• Occupational Therapy Assistant in Reading, PA
• Providers in Reading, PA by specialty
• Occupational Therapy Assistant in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.