Healthcare Provider Details

I. General information

NPI: 1003407594
Provider Name (Legal Business Name): JAMIE E WAHL OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2021
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 MARKET ST UNIT 210
SAN DIEGO CA
92101-6767
US

IV. Provider business mailing address

235 MARKET ST UNIT 210
SAN DIEGO CA
92101-6767
US

V. Phone/Fax

Practice location:
  • Phone: 303-710-2520
  • Fax:
Mailing address:
  • Phone: 303-710-2520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT21890
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: