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NPI Code Detail

MEDICARE: JENNIFER WILSON

MEDICARE: JENNIFER WILSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1222Q00000XDevelopmental Therapist

General Provider Information

NPI Number : 1316358302
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER WILSON
Provider Business Mailing Address
First Line : 32 CRESCENT ST
Second Line :
City : KINGSTON
State : MA
Zip : 02364-2255
Country : US
Telephone Number : 508-747-2012
Fax Number :
Provider Business Practice Location Address
First Line : 32 CRESCENT ST
Second Line :
City : KINGSTON
State : MA
Zip : 02364-2255
Country : US
Telephone Number : 508-747-2012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2014
Last Update Date : 05/13/2014

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Directions to “ JENNIFER WILSON ” Practice Location

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