Individual
CASSANDRA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4495 E GIRO RD, HAZLETON, IN 47640-9303
(812) 664-8531
Mailing address
4495 E GIRO RD, HAZLETON, IN 47640-9303
(812) 664-8531
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
06002568A
IN
Other
Enumeration date
05/22/2015
Last updated
05/22/2015
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