Individual
MR. CLAYTON MATTHEW WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
A.T., C., O.T.C.
Contact information
Practice address
4140 CENTENNIAL HILLS BLVD, CASPER, WY 82609-3265
(307) 265-7205
(307) 235-6262
Mailing address
4140 CENTENNIAL HILLS BLVD, CASPER, WY 82609-3265
(307) 265-7205
(307) 235-6262
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
087
WY
246ZX2200X
Orthopedic Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
087
CERTIFIED ATHLETIC TRAINER
WY
01
—
16-0200
CERTIFIED ORTHOPEDIC TECHNOLOGIST
WY
Enumeration date
03/27/2006
Last updated
04/12/2016
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