Individual
MRS. MICKENZIE FARRELL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
366 E MESA VERDE LN, LAS VEGAS, NV 89123-1812
(702) 227-4477
Mailing address
1354 ROSSINI ST, HENDERSON, NV 89052-5552
(702) 292-8160
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
15-0549
NV
Other
Enumeration date
02/05/2015
Last updated
02/05/2015
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