Provider Demographics
NPI:1366657801
Name:WRYALS, JOSEPHINE (OTR)
Entity Type:Individual
Prefix:MS
First Name:JOSEPHINE
Middle Name:
Last Name:WRYALS
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 1:14000 NW 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33168-4851
Mailing Address - Country:US
Mailing Address - Phone:305-681-9900
Mailing Address - Fax:305-681-9179
Practice Address - Street 1:14000 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33168-4851
Practice Address - Country:US
Practice Address - Phone:305-681-9900
Practice Address - Fax:305-681-9179
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2990225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887051900Medicaid