Individual
STEPHANIE WILDERMUTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
10401 W CHARLESTON BLVD, LAS VEGAS, NV 89135-1151
(702) 207-4229
Mailing address
10401 W CHARLESTON BLVD, LAS VEGAS, NV 89135-1151
(702) 207-4229
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
16-1316
NV
Other
Enumeration date
02/28/2019
Last updated
02/28/2019
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