Individual
WENDI RAE KODALEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
12842 TILDEN DR, RANCHO CUCAMONGA, CA 91739-1805
(909) 747-7366
Mailing address
12842 TILDEN DR, RANCHO CUCAMONGA, CA 91739-1805
(909) 747-7366
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA1043
CA
Other
Enumeration date
06/20/2022
Last updated
06/20/2022
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