Individual
SAMANTHA WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AT, M.P.M
Contact information
Practice address
2980 N GENOA CLAY CENTER RD, GENOA, OH 43430-9733
(419) 392-4585
Mailing address
2980 N GENOA CLAY CENTER RD, GENOA, OH 43430-9733
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36001940A
IN
2255A2300X
Athletic Trainer
Primary
AT.004339
OH
Other
Enumeration date
08/05/2014
Last updated
04/17/2015
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