Provider Demographics
NPI:1386134666
Name:WILSON, VICTORIA KALENE (ATC)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:KALENE
Last Name:WILSON
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 N AYRSHIRE CIR
Mailing Address - Street 2:
Mailing Address - City:CAMBY
Mailing Address - State:IN
Mailing Address - Zip Code:46113-9635
Mailing Address - Country:US
Mailing Address - Phone:317-292-2014
Mailing Address - Fax:
Practice Address - Street 1:801 MACARTHUR BLVD STE 405
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2919
Practice Address - Country:US
Practice Address - Phone:219-836-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2018-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer