Individual
MARY SAMOGE-WISMER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
18480 COCHRAN BLVD, PORT CHARLOTTE, FL 33948-3379
(941) 743-4700
Mailing address
3054 MANCINI TER, PUNTA GORDA, FL 33983-3311
(941) 916-0340
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
OT9256
FL
Other
Enumeration date
08/25/2015
Last updated
08/25/2015
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