Individual
AMANDA J WISEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
917 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906-1443
(765) 463-2200
(765) 463-3625
Mailing address
PO BOX 4699, LAFAYETTE, IN 47903-4699
(765) 449-2732
(765) 449-1196
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002137A
IN
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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