Individual
FAYOLA TRINEICE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
906 FAGAN DRIVE, UNIT 6-B, HAMMOND, LA 70403-5807
(985) 318-0662
Mailing address
906 FAGAN DRIVE, UNIT 6-B, HAMMOND, LA 70403-5807
(985) 318-0662
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
LA5480
LA
302R00000X
Health Maintenance Organization
LMT5480
LA
Other
Enumeration date
08/18/2016
Last updated
09/13/2016
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