Provider Demographics
NPI:1477257343
Name:WILSON, DODI KATRINA (LMT)
Entity Type:Individual
Prefix:MISS
First Name:DODI
Middle Name:KATRINA
Last Name:WILSON
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:394 TUSCARAWAS ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6646
Mailing Address - Country:US
Mailing Address - Phone:740-504-3332
Mailing Address - Fax:
Practice Address - Street 1:399 S 22ND ST STE A
Practice Address - Street 2:
Practice Address - City:HEATH
Practice Address - State:OH
Practice Address - Zip Code:43056-1652
Practice Address - Country:US
Practice Address - Phone:740-504-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-27
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33.025980225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist