Individual
SHAWNEEN WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LYMPHEDEMA THERAPIST
Contact information
Practice address
114 W 11TH ST, SILVER CITY, NM 88061-5136
(575) 388-1511
Mailing address
PO BOX 34, HURLEY, NM 88043-0034
(575) 537-2867
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
224Z00000X
Occupational Therapy Assistant
1627
NM
Other
Enumeration date
09/05/2008
Last updated
12/10/2021
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