Individual
MR. JASON ERIC WYLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
12803 LENOVER ST, DILLSBORO, IN 47018-9418
(812) 432-5226
Mailing address
510B PEARL ST, VEVAY, IN 47043-8414
(812) 801-7590
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002153A
IN
Other
Enumeration date
11/12/2012
Last updated
11/12/2012
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