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Individual
MS. MIRANDA WADDLE
Active
Individual
MS. MIRANDA WADDLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
25256
CA
320800000X
Mental Illness Community Based Residential Treatment Facility
—
—
Other
Enumeration date
07/27/2023
Last updated
11/24/2023
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