Individual
JACOB WILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
104 BRAMBLEWOOD DR, STATESVILLE, NC 28625-2169
(704) 880-6314
Mailing address
104 BRAMBLEWOOD DR, STATESVILLE, NC 28625-2169
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
02/20/2021
Last updated
02/20/2021
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