Individual
MRS. TRACY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2422 SAINT GEORGE WAY, BROOKEVILLE, MD 20833-3265
(301) 570-8415
(301) 570-8415
Mailing address
2422 SAINT GEORGE WAY, BROOKEVILLE, MD 20833-3265
(301) 570-8415
(301) 570-8415
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
03971
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
J917-0001
BCBS PROVIDER NUMBER
MD
Enumeration date
12/26/2006
Last updated
07/08/2007
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