Individual
MRS. NICOLE M. WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.O.T.A.
Contact information
Practice address
1801 GRAND ISLAND BLVD, GRAND ISLAND, NY 14072-2171
(716) 773-4323
Mailing address
448 ASHFORD AVE, TONAWANDA, NY 14150-7002
(716) 773-4323
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
004839-1
NY
Other
Enumeration date
09/23/2010
Last updated
09/23/2010
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