Provider Demographics
NPI:1497251300
Name:WILT, MARIA OGDEN (MS,PT)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:OGDEN
Last Name:WILT
Suffix:
Gender:F
Credentials:MS,PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 W WACKERLY ST STE 500
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-7264
Mailing Address - Country:US
Mailing Address - Phone:989-832-4220
Mailing Address - Fax:989-832-4227
Practice Address - Street 1:304 W WACKERLY ST STE 500
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-7264
Practice Address - Country:US
Practice Address - Phone:989-832-4220
Practice Address - Fax:989-832-4227
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-02
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI55010021152251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic