Provider Demographics
NPI:1841401270
Name:WILLSON, WENDY ANN (LMT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:ANN
Last Name:WILLSON
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 1:4917 WILLIAM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LANCASTER
Mailing Address - State:NY
Mailing Address - Zip Code:14086-3200
Mailing Address - Country:US
Mailing Address - Phone:716-353-5381
Mailing Address - Fax:
Practice Address - Street 1:4971 WILLIAM ST
Practice Address - Street 2:SUITE A
Practice Address - City:LANCASTER
Practice Address - State:NY
Practice Address - Zip Code:14086-9665
Practice Address - Country:US
Practice Address - Phone:716-353-5381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018842225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist