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NPI Code Detail

MEDICARE: TRACY MARIE WILSON

MEDICARE: TRACY MARIE 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
1225X00000XOccupational Therapist11778FL

General Provider Information

NPI Number : 1881876761
Entity Type Code : Individual
Provider Name (Legal Business Name) : TRACY MARIE WILSON
Provider Business Mailing Address
First Line : 1932 STARDUST DR
Second Line :
City : CLEARWATER
State : FL
Zip : 33755-1643
Country : US
Telephone Number : 727-236-0097
Fax Number :
Provider Business Practice Location Address
First Line : 1485 INTERNATIONAL PKWY
Second Line : SUITES 2051
City : LAKE MARY
State : FL
Zip : 32746-5303
Country : US
Telephone Number : 800-798-6035
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/03/2007
Last Update Date : 12/03/2007

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Directions to “ TRACY MARIE WILSON ” Practice Location

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