Provider Demographics
NPI:1003407594
Name:WAHL, JAMIE E (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:E
Last Name:WAHL
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 MARKET ST UNIT 210
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-6767
Mailing Address - Country:US
Mailing Address - Phone:303-710-2520
Mailing Address - Fax:
Practice Address - Street 1:235 MARKET ST UNIT 210
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-6767
Practice Address - Country:US
Practice Address - Phone:303-710-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT21890225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist