Individual
MS. WANDA JEAN CHISCOLM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
6351 N. FORT APACHE RD., LAS VEGAS, NV 89149
(702) 686-6469
(971) 206-5203
Mailing address
4560 SE INTERNATIONAL WAY, STE. 100, MILWAUKIE, OR 97222
(971) 206-5200
(971) 206-5203
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1079
NV
Other
Enumeration date
08/17/2011
Last updated
08/16/2012
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