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General NPI Number Information
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NPI Number | 1154549814
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Entity Type | Individual
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Provider Name | HOLLY M WILSON LMT
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 221 S. 6TH ST.
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City | IRONTON
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State | OH
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Zip | 45638
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Country | US
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Telephone | 740-533-0550
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Fax | 740-534-1111
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Provider Business Mailing Address
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Address Line | 5153 CO. RD. 16
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City | PEDRO
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State | OH
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Zip | 45659
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Country | US
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Telephone | 740-643-2396
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Fax |
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 16010
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License Number State | OH
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