Provider Demographics
NPI:1639107766
Name:WISE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:WISE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:386-290-9383
Mailing Address - Street 1:315 RIO PINAR DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-3707
Mailing Address - Country:US
Mailing Address - Phone:386-290-9383
Mailing Address - Fax:
Practice Address - Street 1:495 S NOVA RD
Practice Address - Street 2:SUITE 112
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8470
Practice Address - Country:US
Practice Address - Phone:386-677-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty