Doctor Name: | MS. JONTE MONIQUE WILSON |
NPI Number: | 1518116565 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS,OTR/L |
License Number: | 014789-1 |
Business Practice Address: | 1025 Ridge Rd Lackawanna, NY - 142181755 |
Business Phone Number: | 7168224781 |
Business Fax Number: | 7168255765 |
Mailing Address: | 39 Deerfield Ave, BUFFALO |
State: | NY |
Postal Code: | 142153005 |
Phone Number: | 7168975465 |
Fax Number: | 7168975465 |
NPI Enumeration Date: | 09/15/2008 |
NPI Last Update Date: | 09/15/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 014789-1 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |