Active NPI
Marion Ellen Wilm, OTR/L
- Occupational Therapist
- Charlotte, NC
National Provider Identifier
1699735423
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 1830
- Practice address
- 4012 Park Rd Ste 200
Charlotte, NC 28209-2378 - Phone
- (704) 541-9080
- Fax
- (704) 542-0699
- NPI assigned
- Mar 24, 2006
- Sex
- Female
- 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 | 1830 | NC | Primary |
Addresses
Primary practice location
4012 Park Rd Ste 200
Charlotte, NC 28209-2378
Mailing address
4012 Park Rd Ste 200
Charlotte, NC 28209-2378
Phone (704) 541-9080
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7388153 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1830 | NC | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752019200000",
"number": "1699735423",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4012 PARK RD STE 200",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282092378",
"telephone_number": "704-541-9080",
"fax_number": "704-542-0699"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4012 PARK RD STE 200",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282092378",
"telephone_number": "704-541-9080",
"fax_number": "704-542-0699"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILM",
"first_name": "MARION",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "OTR/L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-24",
"last_updated": "2025-07-09",
"certification_date": "2025-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "NC",
"license": "1830",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7388153",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.