Individual
DESTANIE ALISSA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
425 S AUSTIN ST, MAXTON, NC 28364-2138
(910) 542-1878
Mailing address
25380 STONY MOUNTAIN RD, ALBEMARLE, NC 28001-8684
(850) 867-4608
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
15974
NC
Other
Enumeration date
07/01/2020
Last updated
01/11/2024
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