Individual
MICHELLE ANNE WILDMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
122 EGLIN PKWY NE, FORT WALTON BEACH, FL 32548-4917
(850) 543-6227
(850) 863-9974
Mailing address
852 RADFORD CT, SHALIMAR, FL 32579-2169
(850) 543-6227
(850) 863-9974
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
11903
FL
Other
Enumeration date
01/27/2007
Last updated
07/08/2007
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