Basic Information
| Provider Information | |||||||||
| NPI: | 1053682989 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHEAT | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | WILSON | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 S LOOP 250 W | ||||||||
| Address2: | |||||||||
| City: | MIDLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797032134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326892100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 808 TOWER DR | ||||||||
| Address2: | SUITE 7 | ||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 79761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4323358777 | ||||||||
| FaxNumber: | 4323358787 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2012 | ||||||||
| LastUpdateDate: | 08/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | 110656 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.