Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 2028 | AL |
NPI | 1003844002 |
---|---|
Provider Name | Sylvia A. Wiseman |
First Address | Gadsden, AL 35904-4938 |
Second Address | Gadsden, AL 35904-4938 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P79229 | (02) | AL |