Individual
TANIA MICHELLE WILCOX
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
702 POTENZA DR APT A, CHARLOTTE, NC 28262-4601
(585) 664-6874
Mailing address
702 POTENZA DR APT A, CHARLOTTE, NC 28262-4601
(585) 664-6874
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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