Individual
EDWIN GULTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA
Contact information
Practice address
16890 GREEN TREE BLVD, VICTORVILLE, CA 92395-5618
(760) 245-5361
Mailing address
906 KENSINGTON DR, REDLANDS, CA 92374-4927
(909) 255-1223
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2010
CA
Other
Enumeration date
09/29/2010
Last updated
09/29/2010
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