Individual
TERRY WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
116 N MAIN ST, SHAWANO, WI 54166-2356
(715) 526-7370
(715) 526-7294
Mailing address
116 N MAIN ST, SHAWANO, WI 54166-2356
(715) 526-7370
(715) 526-7294
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
445-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41076100
—
WI
Enumeration date
10/10/2008
Last updated
10/10/2008
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