Provider Demographics
NPI:1073913901
Name:WISEMAN, ELISSA TONDALAYA (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ELISSA
Middle Name:TONDALAYA
Last Name:WISEMAN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:MS
Other - First Name:ELISSA
Other - Middle Name:TONDALAYA
Other - Last Name:FRENCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OTR/L
Mailing Address - Street 1:24633 HUBER HITLER RD
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2515
Mailing Address - Country:US
Mailing Address - Phone:740-703-0995
Mailing Address - Fax:740-420-3881
Practice Address - Street 1:475 WESTERN AVE
Practice Address - Street 2:SUITE E
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-2286
Practice Address - Country:US
Practice Address - Phone:740-702-3120
Practice Address - Fax:740-702-3123
Is Sole Proprietor?:No
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT.005802225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist