Individual
MRS. KATHY DAWN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
102 MCCLURE DR, SCOTT DEPOT, WV 25560-9439
(304) 757-2670
Mailing address
102 MCCLURE DR, SCOTT DEPOT, WV 25560-9439
(304) 757-2670
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1999-0246
WV
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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