Individual
DIANE WATJEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.T.
Contact information
Practice address
10861 GULCH VIEW DRIVE, MENDOCINO, CA 95460
(707) 937-4235
Mailing address
10861 GULCH VIEW DR, MENDOCINO, CA 95460-8716
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
6765
CA
Other
Enumeration date
04/01/2009
Last updated
11/13/2009
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