Individual
MARY C WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
1335 NW BROAD ST, MURFREESBORO, TN 37129-4428
(615) 896-6400
(615) 896-5177
Mailing address
79 6TH AVE, GRINNELL, IA 50112
(615) 896-6400
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
00967
IA
Other
Enumeration date
10/23/2009
Last updated
10/23/2009
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