Individual
MRS. MIRANDA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S.
Contact information
Practice address
21 OSPREY RD, BECKLEY, WV 25801-1605
(205) 393-4570
Mailing address
218 HESLEP AVE, FAYETTEVILLE, WV 25840-1145
(205) 393-4570
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
11169
MA
225X00000X
Occupational Therapist
120505
TX
225X00000X
Occupational Therapist
Primary
2125
WV
Other
Enumeration date
03/20/2014
Last updated
12/08/2021
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