Individual
TIFFANY LYNN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
1740 NICHOLASVILLE RD, LEXINGTON, KY 40503-1431
(859) 260-6144
(859) 260-6430
Mailing address
2312 SUNNINGDALE DR, LEXINGTON, KY 40509-8514
(859) 264-0242
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
KY-R1330
KY
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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