Individual
MICHELLE WILSON WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
4366 BLACK OAK LANE, MASON, OH 45040
(513) 229-3674
Mailing address
4366 BLACK OAK LN, MASON, OH 45040-8436
(513) 229-3674
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA03107
OH
Other
Enumeration date
09/20/2010
Last updated
09/20/2010
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