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Individual

MRS. AUTUMN R WADE

Active
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Individual

MRS. AUTUMN R WADE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR L, CLT

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
0119004134
VA
225X00000X
Occupational Therapist
Primary
05586
MD
225X00000X
Occupational Therapist
OC009784
PA

Other

Enumeration date
07/31/2006
Last updated
09/24/2008
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