MEDICARE: CYNTHIA ANN WILSON OTA/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
1	224Z00000X	Occupational Therapy Assistant	OTA544	FL
2	222Q00000X	Developmental Therapist	OTA 544	FL

General Provider Information

NPI Number	:	1922279090
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA ANN WILSON OTA/L

Provider Business Mailing Address
First Line	:	1779 N CONGRESS AVE # 398
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-8205
Country	:	US
Telephone Number	:	561-731-1975
Fax Number	:

Provider Business Practice Location Address
First Line	:	7273 SAINT ANDREWS RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-1316
Country	:	US
Telephone Number	:	561-543-5881
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	05/13/2011

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