Individual
ALIZA MARIE DEWILDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTRL
Contact information
Practice address
100 SUNSET DR, NEWARK, NY 14513-1068
(315) 332-2722
Mailing address
100 SUNSET DR, NEWARK, NY 14513-1068
(315) 332-2722
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
019920
NY
Other
Enumeration date
11/06/2018
Last updated
11/06/2018
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