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General NPI Number Information
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NPI Number | 1639389000
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Entity Type | Individual
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Provider Name | KIMBERLY MARIE WISNYAI
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Gender | Female
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5531 US RT 6
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City | ANDOVER
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State | OH
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Zip | 44003
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Country | US
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Telephone | 440-293-7278
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Fax |
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Provider Business Mailing Address
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Address Line | 3162 E MAIN ST
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City | KINGSVILLE
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State | OH
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Zip | 44048
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Country | US
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Telephone | 440-224-0574
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | 01208-OTA
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License Number State | OH
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