Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | ||
N | 225XG0600X | Occupational Therapist - Gerontology | ||
N | 225XH1200X | Occupational Therapist - Hand |
NPI | 1942513379 |
---|---|
Provider Name | Amberly Wiese |
First Address | Malvern, IA 51551-0178 |
Second Address | Malvern, IA 51551-8008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/07/2010 |
Last Update Date | 19/09/2019 |