NPI 1851675219

Tara E Wise, MSOTRL

Practitioner Military Health Care Provider Fort Drum, NY

Practice location

Address: 11050 Mount Belvedere Blvd, Fort Drum, NY 13602-5438
Phone: (315) 772-3380

Registered specialties

Military Health Care Provider Primary

Other Service Providers Taxonomy 171000000X Licence 016540-1 (NY)

Other Military Health Care Provider providers in New York →

Registry record

NPI: 1851675219
Entity type: Individual
Sex (as registered): Female
NPI issued: 4 Oct 2011
Record last updated: 4 Oct 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.