MR. Andrew Melbon Gultom, COTA
NPI #1518159409 in Banning, California
Provider Information
- NPI Number
- 1518159409
- Entity Type
- Individual
- Name
- MR. Andrew Melbon Gultom, COTA
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Occupational Therapy Assistant
- Credential
- COTA
- Enumeration Date
- Aug 14, 2007
- Last Updated
- Aug 14, 2007
Practice Location
- Address
- 1065 DRIFTWOOD CIR
- City
- Banning
- State
- California
- ZIP Code
- 92220-6321
- Phone
- (909) 856-6625
Specialties & Taxonomy Codes
| Specialty |
|---|
| Occupational Therapy Assistant |
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