Individual
SUSAN CAROL WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1120 15TH ST # 2902, AUGUSTA, GA 30912-0004
(706) 721-5223
(706) 721-5228
Mailing address
1446 HARPER ST, AUGUSTA, GA 30912-0012
(706) 721-5223
(706) 721-5228
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA 000112
GA
Other
Enumeration date
03/19/2013
Last updated
03/19/2013
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