Individual
MR. STACY ALLIEOU WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
4920 RAEFORD RD, FAYETTEVILLE, NC 28304-3142
(910) 585-8308
Mailing address
1002 WILLOW DR APT 26, CHAPEL HILL, NC 27514-2933
(336) 847-0093
(208) 246-2255
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7684
NC
Other
Enumeration date
10/06/2010
Last updated
10/06/2010
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