Individual
RICHARD LEE WILDE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
1108 W KILPATRICK ST, CLEBURNE, TX 76033-7477
(817) 202-9520
(817) 202-0017
Mailing address
538 SIMS DR, CEDAR HILL, TX 75104-7711
(469) 272-0887
(817) 202-0017
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
208464
TX
Other
Enumeration date
08/29/2008
Last updated
08/29/2008
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