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NPI Code Detail

MEDICARE: CYNTHIA L WILSON MS OTR/L

MEDICARE: CYNTHIA L WILSON MS OTR/L
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist012293-1NY

General Provider Information

NPI Number : 1083633648
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA L WILSON MS OTR/L
Provider Business Mailing Address
First Line : 182 CRESTWOOD AVE
Second Line :
City : BUFFALO
State : NY
Zip : 14216-2306
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 222 RICHMOND AVE
Second Line :
City : BATAVIA
State : NY
Zip : 14020-1227
Country : US
Telephone Number : 585-297-1125
Fax Number : 585-297-1045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 07/08/2007

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