Individual
KELSEA WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1000 GREENLEY RD, SONORA, CA 95370-5200
(209) 536-5040
Mailing address
1000 GREENLEY RD, SONORA, CA 95370-5200
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
OT16067
CA
Other
Enumeration date
07/10/2017
Last updated
07/10/2017
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