Individual
TAMARAH JANEICE WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
619 PARKVIEW ST, VAN BUREN, AR 72956-2703
(479) 474-8730
Mailing address
19752 SEHORN ST, SPIRO, OK 74959-4418
(918) 208-1669
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A1215
AR
Other
Enumeration date
07/30/2020
Last updated
07/30/2020
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