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Individual

MR. WISLY PAUL

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OT

Contact information

Practice address
65 BERGEN ST, NEWARK, NJ 07107-3001
(973) 972-0186
(973) 972-2645
Mailing address
9 VARSITY RD, NEWARK, NJ 07106-2918
(973) 769-4147

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
46TR00400900
NJ

Other

Enumeration date
04/02/2007
Last updated
07/08/2007
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