Individual
MADISEN BLAIRE WIRTEL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
140 CABARRUS AVE W, CONCORD, NC 28025-5150
(704) 239-6321
Mailing address
195 OBRIEN PL SW, CONCORD, NC 28025-5673
(704) 467-7892
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
12646
NC
Other
Enumeration date
10/19/2020
Last updated
10/19/2020
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