Provider Demographics
NPI:1285386219
Name:WISNER, ELISCIA (OTR/L)
Entity type:Individual
Prefix:
First Name:ELISCIA
Middle Name:
Last Name:WISNER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 EVERETT HULL RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9327
Mailing Address - Country:US
Mailing Address - Phone:440-821-9991
Mailing Address - Fax:
Practice Address - Street 1:5736 ANDOVER ST
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3730
Practice Address - Country:US
Practice Address - Phone:440-821-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-20
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics