Individual
MRS. TRISTA LAINE WISELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
731 N KLEIN CIR, DERBY, KS 67037-7011
(316) 719-2400
Mailing address
235 N TYLER RD, WELLINGTON, KS 67152-8035
(913) 620-9986
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
17-02518
KS
Other
Enumeration date
03/02/2022
Last updated
03/02/2022
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