Individual
CAROLYN DENISE WILLINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
73521 EL PASEO DR, TWENTYNINE PALMS, CA 92277-2536
(909) 528-5616
Mailing address
73521 EL PASEO DR, TWENTYNINE PALMS, CA 92277-2536
(909) 528-5616
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
OTA741
CA
Other
Enumeration date
10/07/2016
Last updated
10/07/2016
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