Active NPI
Tara E Wise, M.S., O.T.R./L
- Military Health Care Provider
- Fort Drum, NY
National Provider Identifier
1851675219
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Military Health Care Provider
- License
- 016540-1
- Practice address
- 11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438 - Phone
- (315) 772-3380
- NPI assigned
- Oct 4, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Military Health Care Provider | 171000000X | 016540-1 | NY | Primary |
Addresses
Primary practice location
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Mailing address
11050 Mount Belvedere Blvd
Fort Drum, NY 13602-5438
Phone (315) 772-3380
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 016540-1 | NY | MD | Military Health Care Provider |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1317686400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1851675219",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11050 MOUNT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025438",
"telephone_number": "315-772-3380"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11050 MOUNT BELVEDERE BLVD",
"city": "FORT DRUM",
"state": "NY",
"postal_code": "136025438",
"telephone_number": "315-772-3380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "TARA",
"middle_name": "E",
"credential": "M.S., O.T.R./L",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2011-10-04",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "171000000X",
"taxonomy_group": "",
"desc": "Military Health Care Provider",
"state": "NY",
"license": "016540-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Drum, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.