MEDICARE: MARCIA LEA WILEY M.S.

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	2814	LA

General Provider Information

NPI Number	:	1477780088
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIA LEA WILEY M.S.

Provider Business Mailing Address
First Line	:	2412 SAINT FRANCIS ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-7233
Country	:	US
Telephone Number	:	337-217-4300
Fax Number	:	337-217-4303

Provider Business Practice Location Address
First Line	:	2412 SAINT FRANCIS ST
Second Line	:
City	:	SULPHUR
State	:	LA
Zip	:	70663-7233
Country	:	US
Telephone Number	:	337-217-4300
Fax Number	:	337-217-4303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	06/22/2009

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Directions to “ MARCIA LEA WILEY M.S.” Practice Location

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