Individual
MR. LYNNE RENEE WILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
3050 BROWN AVE, MOUNT DORA, FL 32757-3453
(352) 383-2208
Mailing address
3050 BROWN AVE, MOUNT DORA, FL 32757-3453
(352) 383-2208
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
11598
FL
Other
Enumeration date
03/08/2011
Last updated
03/08/2011
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