Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT21890 | CA |
NPI | 1003407594 |
---|---|
Provider Name | Jamie E Wahl |
First Address | San Diego, CA 92101-6767 |
Second Address | San Diego, CA 92101-6767 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 28/01/2021 |