Individual
MRS. KIMBERLY ASHTON WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
304 DOCKSER HALL, BOSTON, MA 02115
(617) 373-2664
Mailing address
480 LOG RD, SMITHFIELD, RI 02917-1014
(401) 349-4251
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1465
MA
Other
Enumeration date
11/02/2006
Last updated
07/08/2007
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