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Individual
TERRY ROGER WILSON
Active
Individual
TERRY ROGER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
OTT.Z11857
LA
363A00000X
Physician Assistant
Primary
200134
LA
Other
Enumeration date
05/08/2006
Last updated
06/13/2019
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