Individual
JENNIFER WIERWILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
1021 CEDARS DR, MCPHERSON, KS 67460-2735
(620) 241-0919
Mailing address
506 SE 5TH ST, NEWTON, KS 67114-3822
(316) 871-9059
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
18-01750
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18-01750
KS STATE BOARD OF HEALING ARTS
KS
Enumeration date
03/30/2021
Last updated
03/30/2021
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