Individual
NICOLE MICHELLE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
9901 272ND PL NW, STANWOOD, WA 98292
(360) 510-3518
Mailing address
9901 272ND PL NW, STANWOOD, WA 98292-7449
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
60787684
WA
Other
Enumeration date
09/06/2017
Last updated
09/06/2017
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