Ida M. Gammon-Wilson, LMT, CBT

NPI #1629090519 in Farmingdale, Maine

Provider Information

NPI Number: 1629090519
Entity Type: Individual
Name: Ida M. Gammon-Wilson, LMT, CBT
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Massage Therapist
Credential: LMT, CBT
Enumeration Date: Jul 23, 2006
Last Updated: Jul 8, 2007

Practice Location

Address: 690 MAINE AVE
City: Farmingdale
State: Maine
ZIP Code: 04344-1539
Phone: (207) 622-4062

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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