Individual
TARA E WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., O.T.R./L
Contact information
Practice address
11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602-5438
(315) 772-3380
Mailing address
11050 MOUNT BELVEDERE BLVD, FORT DRUM, NY 13602-5438
(315) 772-3380
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
016540-1
NY
Other
Enumeration date
10/04/2011
Last updated
10/04/2011
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