Provider Demographics
NPI:1245634914
Name:JAMES SCOTT WILEY
Entity type:Organization
Organization Name:JAMES SCOTT WILEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPY ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:WILEY
Authorized Official - Suffix:
Authorized Official - Credentials:COTA
Authorized Official - Phone:512-560-2769
Mailing Address - Street 1:7116 COUNTY ROAD 3730
Mailing Address - Street 2:
Mailing Address - City:PEACE VALLEY
Mailing Address - State:MO
Mailing Address - Zip Code:65788-9780
Mailing Address - Country:US
Mailing Address - Phone:512-560-2769
Mailing Address - Fax:
Practice Address - Street 1:210 DAVIS DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2241
Practice Address - Country:US
Practice Address - Phone:417-256-2152
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-09
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014035221314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility