Individual
CARLY J WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, LAT, ATC
Contact information
Practice address
1109 W MYRTLE ST STE 200, BOISE, ID 83702-6975
(208) 489-4300
Mailing address
1051 SOUTHERN DR UNIT 2108, COLUMBIA, SC 29201-5608
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/10/2018
Last updated
09/09/2021
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