Provider Demographics
NPI:1003844002
Name:WISEMAN, SYLVIA A (OTR)
Entity Type:Individual
Prefix:
First Name:SYLVIA
Middle Name:A
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 OWENS ST
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35904-4938
Mailing Address - Country:US
Mailing Address - Phone:256-543-1030
Mailing Address - Fax:256-439-2830
Practice Address - Street 1:1514 OWENS ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35904-4938
Practice Address - Country:US
Practice Address - Phone:256-543-1030
Practice Address - Fax:256-439-2830
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2028225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALP79229Medicare UPIN