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Individual

DIANE WILSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
COTA

Contact information

Practice address
15 PALMER CT, MAYBROOK, NY 12543-1126
(845) 427-5220
Mailing address
15 PALMER CT, MAYBROOK, NY 12543-1126
(845) 427-5220

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
005173-1
NY

Other

Enumeration date
12/01/2010
Last updated
12/01/2010
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