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General NPI Number Information
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NPI Number | 1114236346
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Entity Type | Individual
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Provider Name | STACY ALLIEOU WILSON OTR/L
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Gender | Male
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 4920 RAEFORD RD
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City | FAYETTEVILLE
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State | NC
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Zip | 28304-3142
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Country | US
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Telephone | 910-585-8308
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Fax |
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Provider Business Mailing Address
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Address Line | 1002 WILLOW DR APT 26
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City | CHAPEL HILL
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State | NC
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Zip | 27514-2933
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Country | US
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Telephone | 336-847-0093
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Fax | 208-246-2255
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 7684
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License Number State | NC
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