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1730427089
GARY WALLUM
SAN DIEGO, CA
NPI
1730427089
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: CA OTA58)
Enumeration Date
2013-01-22
Last Update Date
2013-01-22
Business Address
-- GARY WALLUM COTA/L
3812 PARK BLVD UNIT 104
SAN DIEGO, CA 92103-3679
Phone number: 619-770-8663
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Mailing Address
-- GARY WALLUM COTA/L
3812 PARK BLVD UNIT 104
SAN DIEGO, CA 92103-3679
Phone number: 619-770-8663
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