Individual
JILL MARIE WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
1256 BRANDY LAKE RD, ARBOR VITAE, WI 54568-0827
(715) 356-9729
(715) 358-5209
Mailing address
N12041 BREED RD, CLINTONVILLE, WI 54929-9539
(715) 823-3983
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
518-027
WI
Other
Enumeration date
12/01/2006
Last updated
07/08/2007
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