Individual
MAGDALENA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC/L
Contact information
Practice address
110 WOODBURY RD, WATERTOWN, CT 06795-2130
(860) 945-7713
Mailing address
31 WARREN WAY, WATERTOWN, CT 06795-2113
(860) 961-3251
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
001045
CT
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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