Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT13641 | FL |
NPI | 1003147489 |
---|---|
Provider Name | Nicole Wilson |
First Address | Davie, FL 33324-7123 |
Second Address | Davie, FL 33314-7721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2010 |
Last Update Date | 18/11/2010 |