Individual
MRS. TANYA LEILA WILD-PEACH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS OTR/L
Contact information
Practice address
1015 AMBOY AVE, GRS HERITAGE AT CLARA BARTON, EDISON, NJ 08837-2825
(732) 346-9700
Mailing address
230 GEARY DR, SOUTH PLAINFIELD, NJ 07080-2910
(908) 756-3689
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
46TR00486800
NJ
Other
Enumeration date
09/03/2010
Last updated
09/03/2010
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