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General NPI Number Information
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NPI Number | 1467701789
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Entity Type | Individual
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Provider Name | KERWIN WAYNE WILSON ORTHOTIC FITTER
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Gender | Male
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Dates
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Enumeration Date | 08/31/2012
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Last Update Date | 08/31/2012
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Provider Practice Location Address
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Address Line | 7474 SKILLMAN ST. # 501
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City | DALLAS
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State | TX
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Zip | 75231
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Country | US
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Telephone | 214-966-3342
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Fax | 214-221-1593
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Provider Business Mailing Address
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Address Line | 7474 SKILLMAN ST. # 501
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City | DALLAS
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State | TX
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Zip | 75231
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Country | US
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Telephone | 214-966-3342
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Fax | 214-221-1593
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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 | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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