Individual
COREY KAREEN WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
908 GEORGIA AVE, LEESBURG, FL 34748-3706
(973) 289-7813
Mailing address
PO BOX 1485, EUSTIS, FL 32727-1485
(973) 289-7813
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
—
Other
Enumeration date
02/09/2022
Last updated
02/09/2022
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