Provider Demographics
NPI:1700859386
Name:WILSON, MELINDA DILLARD (ATC)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:DILLARD
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 1:128 ALLYN TRCE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:AL
Mailing Address - Zip Code:35594-6261
Mailing Address - Country:US
Mailing Address - Phone:205-487-7080
Mailing Address - Fax:
Practice Address - Street 1:2631 TEMPLE AVE N
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1157
Practice Address - Country:US
Practice Address - Phone:800-648-3271
Practice Address - Fax:205-932-2153
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0372255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer