Individual
GWENDOLYN WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5659 STADIUM DR, KALAMAZOO, MI 49009-1932
(269) 372-0436
Mailing address
5659 STADIUM DR, KALAMAZOO, MI 49009-1932
(269) 372-0436
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5201007496
MI
Other
Enumeration date
06/13/2016
Last updated
06/13/2016
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