Basic Information
| Provider Information | |||||||||
| NPI: | 1326378084 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | WANDA | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 883 LONG SHADOW LN | ||||||||
| Address2: | |||||||||
| City: | ROAMING SHORES | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440859764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4405635507 | ||||||||
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| Practice Location | |||||||||
| Address1: | 620 WATER STREET | ||||||||
| Address2: | CHARDON HEALTH CARE | ||||||||
| City: | CHARDON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 44024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4402859400 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/31/2009 | ||||||||
| LastUpdateDate: | 12/31/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225200000X | 04179 | OH | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant |
No ID Information.