Individual
TYLER NOELL WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
0 AVENUE D, BUILDING 364, PERRY POINT, MD 21902-1003
(410) 642-2411
Mailing address
0 AVENUE D, BUILDING 364, PERRY POINT, MD 21902-1003
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
08238
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/29/2014
Last updated
03/23/2018
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