Individual
GRETCHEN WILCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
3621 S PIMA DR, FLAGSTAFF, AZ 86001-6520
(928) 220-0723
Mailing address
3621 S PIMA DR, FLAGSTAFF, AZ 86001-6520
(928) 220-0723
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
1041
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504995
—
AZ
Enumeration date
04/19/2007
Last updated
07/09/2007
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