Individual
AMBERLY WIESE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
305 E 1ST ST, MALVERN, IA 51551-8008
(402) 201-7852
Mailing address
PO BOX 178, MALVERN, IA 51551-0178
(402) 201-7852
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XG0600X
Gerontology Occupational Therapist
—
—
225XH1200X
Hand Occupational Therapist
—
—
Other
Enumeration date
07/14/2010
Last updated
09/19/2019
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