Healthcare Provider Details

I. General information

NPI: 1306154547
Provider Name (Legal Business Name): RHONDA WILSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 09/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 CARTER DR
NORTH MONMOUTH ME
04265-6019
US

IV. Provider business mailing address

75 CARTER DR
NORTH MONMOUTH ME
04265-6019
US

V. Phone/Fax

Practice location:
  • Phone: 207-933-9775
  • Fax:
Mailing address:
  • Phone: 207-933-9775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT1668
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: