Provider Demographics
NPI:1346992104
Name:TOLES, WYAKITA WILLENE (BS, CTRS)
Entity Type:Individual
Prefix:
First Name:WYAKITA
Middle Name:WILLENE
Last Name:TOLES
Suffix:
Gender:F
Credentials:BS, CTRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6762 PEMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-4894
Mailing Address - Country:US
Mailing Address - Phone:317-473-9299
Mailing Address - Fax:
Practice Address - Street 1:6762 PEMBRIDGE WAY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-4894
Practice Address - Country:US
Practice Address - Phone:317-473-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation TherapistGroup - Single Specialty