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General NPI Number Information
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NPI Number | 1265866461
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Entity Type | Individual
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Provider Name | TAMMY OWEIDA WILSON LMT
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Gender | Female
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Dates
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Enumeration Date | 08/25/2013
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Last Update Date | 08/25/2013
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Provider Practice Location Address
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Address Line | 161 S LIBERTY ST
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City | POWELL
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State | OH
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Zip | 43065-7619
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Country | US
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Telephone | 614-306-2494
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Fax |
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Provider Business Mailing Address
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Address Line | 217 AARON CT
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City | DELAWARE
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State | OH
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Zip | 43015-3334
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Country | US
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Telephone | 740-417-9221
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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 | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 014227
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License Number State | OH
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