Individual
KISHIA WIGGINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
864 US HWY 158 BUSINESS W, WARRENTON, NC 27589-0618
(252) 257-2121
Mailing address
PO BOX 618, WARRENTON, NC 27589-0618
(252) 257-2121
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
7516
NC
Other
Enumeration date
02/03/2016
Last updated
02/03/2016
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