Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 07564 | MD |
NPI | 1518925734 |
---|---|
Provider Name | Mrs. Susan Jean Wilber |
First Address | Middletown, MD 21769-8101 |
Second Address | Middletown, MD 21769-8101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2006 |
Last Update Date | 21/01/2019 |