MEDICARE: WISE THERAPY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	102122	TX

General Provider Information

NPI Number	:	1013233485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WISE THERAPY SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 9292
Second Line	:	9450 PINECROFT DR.
City	:	SPRING
State	:	TX
Zip	:	77387-9292
Country	:	US
Telephone Number	:	832-418-9274
Fax Number	:	281-288-2502

Provider Business Practice Location Address
First Line	:	2622 SPRINGSTONE DR
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77386-5464
Country	:	US
Telephone Number	:	832-418-9274
Fax Number	:	281-288-2502

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. NOHEMI MARTINEZ-CLEMENT
Credential	:	M.A., CCC-SLP
Telephone Number	:	832-418-9274

Provider Enumeration Date	:	04/10/2010
Last Update Date	:	04/10/2010

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Directions to “WISE THERAPY SERVICES ” Practice Location

Language	Start Address	Practice Location

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