Provider Demographics
NPI:1730726472
Name:WISE, PETER JAMES (OTR/L,CHT, GTS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JAMES
Last Name:WISE
Suffix:
Gender:M
Credentials:OTR/L,CHT, GTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 HOOKS ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-3514
Mailing Address - Country:US
Mailing Address - Phone:352-394-2862
Mailing Address - Fax:352-394-2861
Practice Address - Street 1:2440 HOOKS ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-3514
Practice Address - Country:US
Practice Address - Phone:352-394-2862
Practice Address - Fax:352-394-2861
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019256225XH1200X
FLOT21187225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand