Individual
TARA WILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2708 NE 14TH ST, SUITE 5, POMPANO BEACH, FL 33062-3565
(888) 880-9270
Mailing address
88C SHORELINE DR, JACKSONVILLE, NC 28540-8135
(910) 787-3665
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/24/2011
Last updated
07/24/2011
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