Healthcare Provider Details

I. General information

NPI: 1528717337
Provider Name (Legal Business Name): CAYLAR LOVE WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 MONTGOMERY HWY STE 181
VESTAVIA HILLS AL
35216-3690
US

IV. Provider business mailing address

3462 RIDGE CREST DR
VESTAVIA HILLS AL
35216-4477
US

V. Phone/Fax

Practice location:
  • Phone: 205-410-5666
  • Fax:
Mailing address:
  • Phone: 205-410-5666
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: