Individual
BILLIE WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1073 NEWBURG ST NW APT 3, CANTON, OH 44709-1353
(234) 401-9242
Mailing address
1073 NEWBURG ST NW APT 3, CANTON, OH 44709-1353
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
9828
SC
Other
Enumeration date
12/08/2014
Last updated
12/08/2014
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