Individual
COLLETTE MICHELLE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
95-6040 MAMALAHOA HWY, NAALEHU, HI 96772
(808) 987-7490
Mailing address
PO BOX 721426, NAALEHU, HI 96772-1119
(808) 987-7490
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
MA00021673
WA
225700000X
Massage Therapist
Primary
MAT-12043
HI
Other
Enumeration date
12/05/2006
Last updated
12/14/2023
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