Individual
HEATHER WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RBT
Contact information
Practice address
103 LEWIS ST, FORT WALTON BEACH, FL 32547-3142
(850) 685-1772
Mailing address
103 LEWIS ST, FORT WALTON BEACH, FL 32547-3142
(850) 685-1772
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
RBT-15-10278
FL
Other
Enumeration date
07/17/2016
Last updated
07/17/2016
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