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Individual

AMANDA ROSE VANDER WIEL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT R/L

Contact information

Practice address
706 LA JOYA ST, ESPANOLA, NM 87532-2877
(732) 770-6838
Mailing address
144 HEYER RD, NAZARETH, PA 18064-8773
(732) 770-6838

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
4091
NM

Other

Enumeration date
04/14/2019
Last updated
07/13/2020
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