Individual
NICOLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
485 MOXIE LN, DELPHOS, OH 45833-9182
(419) 692-3405
(419) 692-3400
Mailing address
485 MOXIE LN, DELPHOS, OH 45833-9182
(419) 692-3405
(419) 692-3400
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT.006137
OH
Other
Enumeration date
04/25/2012
Last updated
04/25/2012
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