Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 950 | MT |
NPI | 1023231164 |
---|---|
Provider Name | Mr. David John Wilson |
First Address | Hamilton, MT 59840-9425 |
Second Address | Hamilton, MT 59840-9425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |