Provider Demographics
NPI:1447694534
Name:WYERS, JESSIE
Entity type:Individual
Prefix:
First Name:JESSIE
Middle Name:
Last Name:WYERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9929 RIO SAN DIEGO DR
Mailing Address - Street 2:APT 44
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-5608
Mailing Address - Country:US
Mailing Address - Phone:619-846-2434
Mailing Address - Fax:
Practice Address - Street 1:3877 SIX MILE ROAD
Practice Address - Street 2:SUITE 209
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152
Practice Address - Country:US
Practice Address - Phone:734-452-0395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9317225X00000X
MI5201008479225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist