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General NPI Number Information
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NPI Number | 1285546093
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Entity Type | Individual
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Provider Name | ANGELINA OCONNOR WILSON RBT
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Gender | Female
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 1242 W SHIPLEY FERRY RD
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City | KINGSPORT
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State | TN
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Zip | 37663-3323
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Country | US
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Telephone | 423-815-8336
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Fax |
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Provider Business Mailing Address
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Address Line | 1228 MEADOWVIEW AVE
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City | JOHNSON CITY
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State | TN
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Zip | 37601-2340
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Country | US
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Telephone |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-277066
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License Number State | TN
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