Provider Demographics
NPI:1073949483
Name:PAMELA J WILSON DBA DISCOVERY PLAY
Entity Type:Organization
Organization Name:PAMELA J WILSON DBA DISCOVERY PLAY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-305-7928
Mailing Address - Street 1:106 QUAIL RUN
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3239
Mailing Address - Country:US
Mailing Address - Phone:252-305-7928
Mailing Address - Fax:
Practice Address - Street 1:106 QUAIL RUN
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3239
Practice Address - Country:US
Practice Address - Phone:252-305-7928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-17
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency