Individual
DONNA JEAN WICAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
11201 BENTON ST, LOMA LINDA, CA 92357-1000
(909) 825-7084
Mailing address
626 LAKESIDE AVE, REDLANDS, CA 92373-5788
(909) 783-8638
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
3135
CA
Other
Enumeration date
08/18/2006
Last updated
07/08/2007
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