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General NPI Number Information
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NPI Number | 1356099964
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Entity Type | Individual
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Provider Name | TAMARA OLIVE WILSON RCSWI
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Gender | Female
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Dates
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Enumeration Date | 03/13/2022
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 11105 SW 200TH ST
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City | CUTLER BAY
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State | FL
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Zip | 33157-8296
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Country | US
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Telephone | 786-443-6542
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Fax |
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Provider Business Mailing Address
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Address Line | 26493 SW 149TH AVE
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City | HOMESTEAD
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State | FL
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Zip | 33032-5331
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Country | US
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Telephone | 305-481-8118
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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-21-187005
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ISW18415
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License Number State | FL
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