Individual
RACHELLE WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
525 E 162ND ST, SOUTH HOLLAND, IL 60473-2384
(219) 210-1584
Mailing address
7409 163RD PL, TINLEY PARK, IL 60477-1550
(219) 210-1584
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
057.004108
IL
Other
Enumeration date
11/26/2017
Last updated
11/26/2017
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