Provider Demographics
NPI:1376567537
Name:WILMER, LINDA (CMT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:WILMER
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:STEPHENS CITY
Mailing Address - State:VA
Mailing Address - Zip Code:22655-2343
Mailing Address - Country:US
Mailing Address - Phone:540-869-4097
Mailing Address - Fax:
Practice Address - Street 1:122G AGAPE WAY
Practice Address - Street 2:
Practice Address - City:STEPHENS CITY
Practice Address - State:VA
Practice Address - Zip Code:22655-2211
Practice Address - Country:US
Practice Address - Phone:540-868-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019004169174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist