Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 8106 | MA |
NPI | 1083895254 |
---|---|
Provider Name | Karen Wilson |
First Address | Leominster, MA 01453-2547 |
Second Address | Leominster, MA 01453-1804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2007 |
Last Update Date | 16/11/2007 |