Provider Demographics
NPI:1811053457
Name:WILSON, NANCY ELIZABETH (LCMT)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ELIZABETH
Last Name:WILSON
Suffix:
Gender:F
Credentials:LCMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:28 CASWELL STREET
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:NARRAGANSETT
Mailing Address - State:RI
Mailing Address - Zip Code:02882-3385
Mailing Address - Country:US
Mailing Address - Phone:401-783-1670
Mailing Address - Fax:401-789-6990
Practice Address - Street 1:28 CASWELL STREET
Practice Address - Street 2:SUITE 1100
Practice Address - City:NARRAGANSETT
Practice Address - State:RI
Practice Address - Zip Code:02882-3385
Practice Address - Country:US
Practice Address - Phone:401-783-1670
Practice Address - Fax:401-789-6990
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMT00064225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist