Individual
SIMON WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
110 W WISSAHICKON AVE, FLOURTOWN, PA 19031-1802
(215) 836-4179
Mailing address
17 STEVENS CT, SOMERDALE, NJ 08083-3007
(469) 396-3214
Taxonomy
Speciality
Code
Description
License number
State
224ZF0002X
Feeding, Eating & Swallowing Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
02/14/2019
Last updated
02/14/2019
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