Individual
SHELLEY WIESEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
4609 GRAPE RD, STE B-7, MISHAWAKA, IN 46545-2649
(574) 360-8132
(888) 370-2324
Mailing address
4609 GRAPE RD, SUITE B-7, MISHAWAKA, IN 46545-2649
(574) 360-8132
(888) 370-2324
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31003555A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200876300
—
IN
Enumeration date
09/05/2007
Last updated
07/13/2011
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