Individual
MRS. TAWNY L WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
7540 N 19TH AVE, PHOENIX, AZ 85021-7967
(888) 873-4221
Mailing address
501 N PARK ST, MANZANOLA, CO 81058-9612
(719) 462-5683
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1000056
CA
Other
Enumeration date
08/01/2008
Last updated
08/01/2008
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