Individual
MRS. KRISTIN MANNINA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
5301 CREEDMOOR RD, RALEIGH, NC 27612-3822
(919) 651-3803
Mailing address
2029 LONGWOOD DR, RALEIGH, NC 27612-2814
(919) 280-1436
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
11976
NC
Other
Enumeration date
03/06/2018
Last updated
10/12/2018
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