Individual
DEBORAH M WISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
1220 E. LAGUNA, KOKOMO, IN 46902
(765) 454-5340
(765) 454-5347
Mailing address
1220 E. LAGUNA, KOKOMO, IN 46902
(765) 454-5340
(765) 454-5347
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32000113A
IN
Other
Enumeration date
05/01/2007
Last updated
07/08/2007
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