Individual
EVELYN REBECCA BECKY WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
C.O.T.A.
Contact information
Practice address
710 SELLERS RD, MOSELLE, MS 39459-9419
(601) 408-3443
Mailing address
710 SELLERS RD, MOSELLE, MS 39459-9419
(601) 408-3443
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
MS
Other
Enumeration date
06/17/2014
Last updated
06/17/2014
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