Individual
MRS. JENNIFER DEGEYTER WISDOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
210 CHAMPAGNE BLVD, BREAUX BRIDGE, LA 70517-3700
(337) 507-1106
Mailing address
4752 BRIDGE STREET HWY, ST. MARTINVILLE, LA 70582
(337) 845-4880
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
Z20509
LA
Other
Enumeration date
06/11/2009
Last updated
06/11/2009
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