Individual
TASHA WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
770 E GERONIMO ST, CHANDLER, AZ 85225-6494
(417) 209-3330
Mailing address
770 E GERONIMO ST, CHANDLER, AZ 85225-6494
(417) 209-3330
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
4964
AZ
Other
Enumeration date
10/20/2011
Last updated
10/20/2011
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