Individual
WANDA WILMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
767 W GRANADA BLVD APT 4303, 767 W GRANADA BLVD APT 4303, ORMOND BEACH, FL 32174-9442
(386) 610-4190
Mailing address
767 W GRANADA BLVD APT 4303, 767 W GRANADA BLVD APT 4303, ORMOND BEACH, FL 32174-9442
(386) 610-4190
Taxonomy
Speciality
Code
Description
License number
State
251C00000X
Developmentally Disabled Services Day Training Agency
Primary
—
FL
Other
Enumeration date
12/19/2025
Last updated
12/19/2025
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