Individual
MRS. BRENDA IRVIN WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MT-BC
Contact information
Practice address
316 CARDINAL DR, MEDINA, OH 44256-2806
(330) 764-3127
Mailing address
316 CARDINAL DR, MEDINA, OH 44256-2806
(330) 764-3127
Taxonomy
Speciality
Code
Description
License number
State
225A00000X
Music Therapist
Primary
14255
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2450048
—
OH
Enumeration date
04/03/2007
Last updated
07/09/2007
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