Provider Demographics
NPI:1386046282
Name:WIESMAN, MARY LYNN (OTR/L)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LYNN
Last Name:WIESMAN
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:PO BOX 5381
Mailing Address - Street 2:CINCINNATI PUBLIC SCHOOLS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45201-5381
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 W NORTH BEND RD
Practice Address - Street 2:CINCINNATI PUBLIC SCHOOLS
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-2606
Practice Address - Country:US
Practice Address - Phone:513-363-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT3332225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist