Individual
LACIE LEE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1167 MILL RD, NEW JOHNSONVILLE, TN 37134-2370
(731) 845-3443
Mailing address
1167 MILL RD, NEW JOHNSONVILLE, TN 37134-2370
(731) 845-3443
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1995
TN
Other
Enumeration date
07/16/2021
Last updated
07/16/2021
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