Individual
TESHANDRA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
6066 RED SQUIRREL PL, WALDORF, MD 20603-4443
(240) 441-9608
Mailing address
6066 RED SQUIRREL PL, WALDORF, MD 20603-4443
(240) 441-9608
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
MT0084415
MD
Other
Enumeration date
08/27/2014
Last updated
08/27/2014
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