Individual
MS. GWENDA ANN HUMPHERYS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
448 WYLERHORN DR, CRESTLINE, CA 92325-1426
(858) 216-5661
(909) 338-0385
Mailing address
PO BOX 1426, CRESTLINE, CA 92325-1426
(858) 216-5661
(909) 338-0385
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
1372
CA
225X00000X
Occupational Therapist
Primary
AA069575
—
Other
Enumeration date
06/08/2016
Last updated
06/08/2016
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