MEDICARE: SHAELA 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
1	376J00000X	Homemaker		OH

General Provider Information

NPI Number	:	1356092639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAELA WILSON

Provider Business Mailing Address
First Line	:	1219 KENTON ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-3203
Country	:	US
Telephone Number	:	937-844-6286
Fax Number	:

Provider Business Practice Location Address
First Line	:	1219 KENTON ST
Second Line	:
City	:	SPRINGFIELD
State	:	OH
Zip	:	45505-3203
Country	:	US
Telephone Number	:	937-844-6286
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2022
Last Update Date	:	01/18/2022

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Directions to “ SHAELA WILSON ” Practice Location

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