Individual
MISS KRISTY JO WILLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1001 WILDEWOOD DOWNS CIR, COLUMBIA, SC 29223-4434
(803) 419-0431
Mailing address
148 WALL ST APT 115, CAMDEN, SC 29020-7668
(803) 432-0978
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2507
SC
Other
Enumeration date
03/23/2007
Last updated
07/08/2007
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