Individual
MS. DARA J WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CTRS
Contact information
Practice address
5900 BALCONES DR, AUSTIN, TX 78731-4257
(737) 202-9403
Mailing address
5900 BALCONES DR, AUSTIN, TX 78731-4257
(737) 202-9403
Taxonomy
Speciality
Code
Description
License number
State
225800000X
Recreation Therapist
Primary
68853
OH
Other
Enumeration date
09/01/2020
Last updated
09/01/2020
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