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NPI Code Detail

MEDICARE: CRYSTAL WILSON RBT

MEDICARE: CRYSTAL WILSON RBT
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
1106S00000XBehavior TechnicianRBT-15-02132TN

General Provider Information

NPI Number : 1730555186
Entity Type Code : Individual
Provider Name (Legal Business Name) : CRYSTAL WILSON RBT
Provider Business Mailing Address
First Line : 9038 CROSS PARK DR STE 105
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4720
Country : US
Telephone Number : 865-394-6612
Fax Number : 865-315-7014
Provider Business Practice Location Address
First Line : 9038 CROSS PARK DR STE 105
Second Line :
City : KNOXVILLE
State : TN
Zip : 37923-4720
Country : US
Telephone Number : 865-394-6612
Fax Number : 865-315-7014
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2015
Last Update Date : 01/12/2018

Similar Medicare Providers

1780087064 — MS. ELIZABETH ANN GINDER MSSW, BCBA
Practice Location Address:
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1306242250 — IRINA ROBERTS RBT
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1043696370 — MRS. HANNAH ELIZABETH SHEPPLE M.S, BCBA, LBA
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KNOXVILLE, TN
37923-4720
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1780104703 — KELSEY HOLT RBT
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1295243111 — CRESANNA KAHRL BCABA
Practice Location Address:
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KNOXVILLE, TN
37923-4720
Practice Phone: 865-394-6612
Practice Fax: 865-315-7014

Directions to “ CRYSTAL WILSON RBT” Practice Location

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