Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 694-027 | WI |
NPI | 1174672554 |
---|---|
Provider Name | Mary L Wise |
First Address | Madison, WI 53715-1375 |
Second Address | Madison, WI 53715-1375 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 08/07/2007 |