Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225000000X | Orthotic Fitter |
NPI | 1801244389 |
---|---|
Provider Name | Colleen Wendtland |
First Address | Banning, CA 92220-1469 |
Second Address | Banning, CA 92220-1469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2016 |
Last Update Date | 25/05/2016 |