Individual
IDA M. GAMMON-WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT, CBT
Contact information
Practice address
690 MAINE AVE, FARMINGDALE, ME 04344-1539
(207) 622-4062
(207) 622-4062
Mailing address
PO BOX 502, HALLOWELL, ME 04347-0502
(207) 622-4062
(207) 622-4062
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
ME#MT6
ME
Other
Enumeration date
07/23/2006
Last updated
07/08/2007
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