Individual
MIRANDA SUE WISELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
13300 S HIGHWAY 125, MIAMI, OK 74354-5123
(918) 676-6884
Mailing address
13300 S HIGHWAY 125, MIAMI, OK 74354-5123
(918) 676-6884
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2190
OK
Other
Enumeration date
09/15/2021
Last updated
09/15/2021
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