Individual
TEARRA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
501 W 15TH ST APT 115, EDMOND, OK 73013-3648
(405) 437-6149
Mailing address
501 W 15TH ST APT 115, EDMOND, OK 73013-3648
(405) 437-6149
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
03/31/2022
Last updated
03/31/2022
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