Individual
MS. AMBER TANISHA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPHT
Contact information
Practice address
7070 TOMAHAWK TRL, REYNOLDSBURG, OH 43068-4806
(614) 517-9587
Mailing address
7070 TOMAHAWK TRL, REYNOLDSBURG, OH 43068-4806
(614) 517-9587
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
5101-0701-0102-808
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
45-2758598
—
OH
Enumeration date
01/09/2012
Last updated
01/09/2012
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