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Individual
JOHNNY WILSON
Active
Individual
JOHNNY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT1629
MS
Other
Enumeration date
10/29/2009
Last updated
10/29/2009
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