Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 224Z00000X | Occupational Therapy Assistant | 0822 | NH |
NPI | 1023608353 |
---|---|
Provider Name | Daniel Raymond Wise |
First Address | Concord, NH 03301-6906 |
Second Address | Deerfield, NH 03037-1306 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2021 |
Last Update Date | 20/01/2021 |