Provider Demographics
NPI:1730941907
Name:WONDER OT, LLC
Entity type:Organization
Organization Name:WONDER OT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:
Authorized Official - Last Name:JASO
Authorized Official - Suffix:
Authorized Official - Credentials:OTD
Authorized Official - Phone:907-317-8173
Mailing Address - Street 1:5060 VANCE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5653
Mailing Address - Country:US
Mailing Address - Phone:907-317-8173
Mailing Address - Fax:
Practice Address - Street 1:5060 VANCE DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5653
Practice Address - Country:US
Practice Address - Phone:907-317-8173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty