Individual
KATHY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
1525 12TH ST, SUITE #9, FLORENCE, OR 97439-9497
(541) 991-2031
Mailing address
1525 12TH ST, SUITE #9, FLORENCE, OR 97439-9497
(541) 991-2031
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
12018
OR
Other
Enumeration date
06/22/2009
Last updated
06/22/2009
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