Active NPI
Charlene B Wilson
- Occupational Therapy Assistant
- Milton, GA
National Provider Identifier
1801527734
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA002590
- Practice address
- 2925 Webb Rd
Milton, GA 30004-4483 - Phone
- (347) 551-6057
- NPI assigned
- Jun 21, 2022
- 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 Therapy Assistant | 224Z00000X | OTA002590 | GA | Primary |
Addresses
Primary practice location
2925 Webb Rd
Milton, GA 30004-4483
Mailing address
2925 Webb Rd
Milton, GA 30004-4483
Phone (347) 551-6057
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 061605834 | Medicaid | GA | |
| 061605834 | Other | GA | GEORGIA DRIVERS LICENSE |
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 |
|---|---|---|---|
| OTA002590 | GA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655769600000",
"number": "1801527734",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2925 WEBB RD",
"city": "MILTON",
"state": "GA",
"postal_code": "300044483",
"telephone_number": "347-551-6057"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2925 WEBB RD",
"city": "MILTON",
"state": "GA",
"postal_code": "300044483",
"telephone_number": "347-551-6057"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "CHARLENE",
"middle_name": "B",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-06-21",
"last_updated": "2022-06-21",
"certification_date": "2022-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "GA",
"license": "OTA002590",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "061605834",
"state": "GA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GEORGIA DRIVERS LICENSE",
"identifier": "061605834",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Milton, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.