MEDICARE: MS. KATHERINE WILSON B.C.B.A.

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1831334226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHERINE WILSON B.C.B.A.

Provider Business Mailing Address
First Line	:	1404 BEVERLY DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4802
Country	:	US
Telephone Number	:	423-915-6420
Fax Number	:	888-519-4590

Provider Business Practice Location Address
First Line	:	1404 BEVERLY DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23229-4802
Country	:	US
Telephone Number	:	423-915-6420
Fax Number	:	888-519-4590

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

Provider Enumeration Date	:	12/13/2008
Last Update Date	:	06/11/2013

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