Individual
CODIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1113 COOKDALE TRL NW, CLEVELAND, TN 37312-3610
(423) 339-7369
Mailing address
1113 COOKDALE TRL NW, CLEVELAND, TN 37312-3610
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT0000004065
TN
Other
Enumeration date
10/11/2016
Last updated
10/11/2016
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