Individual
MALLORY MARIE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
502 E MARKET ST, NEW SHARON, IA 50207-9757
(641) 895-1478
Mailing address
502 E MARKET ST, NEW SHARON, IA 50207-9757
(641) 895-1478
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
000963
IA
Other
Enumeration date
03/19/2014
Last updated
03/19/2014
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