Individual
GRACE WAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
140 S CHAPARRAL CT STE 160, ANAHEIM, CA 92808-2283
(714) 794-5889
Mailing address
1362 N SCHOONER LN, ANAHEIM, CA 92801-1778
(480) 278-1030
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
5957
CA
Other
Enumeration date
06/27/2022
Last updated
06/27/2022
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