Individual
GARY WALLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
COTA/L
Contact information
Practice address
3812 PARK BLVD, UNIT 104, SAN DIEGO, CA 92103-3679
(619) 770-8663
Mailing address
3812 PARK BLVD, UNIT 104, SAN DIEGO, CA 92103-3679
(619) 770-8663
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA58
CA
Other
Enumeration date
01/22/2013
Last updated
01/22/2013
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