MEDICARE: JULIA WILLSON

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	2255A2300X	Athletic Trainer	ATL22071	MA

General Provider Information

NPI Number	:	1942183744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA WILLSON

Provider Business Mailing Address
First Line	:	122 MARION ST
Second Line	:
City	:	WILMINGTON
State	:	MA
Zip	:	01887-3396
Country	:	US
Telephone Number	:	978-809-1930
Fax Number	:

Provider Business Practice Location Address
First Line	:	1071 BLUE HILL AVE
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-2302
Country	:	US
Telephone Number	:	617-333-2216
Fax Number	:

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

Provider Enumeration Date	:	07/29/2025
Last Update Date	:	07/29/2025

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Directions to “ JULIA WILLSON ” Practice Location

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