Provider Demographics
NPI:1700844974
Name:WUITSCHICK, DOLLY CECILIA (ATC, PTA)
Entity Type:Individual
Prefix:MRS
First Name:DOLLY
Middle Name:CECILIA
Last Name:WUITSCHICK
Suffix:
Gender:F
Credentials:ATC, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 S H ST
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93436-7813
Mailing Address - Country:US
Mailing Address - Phone:805-736-2900
Mailing Address - Fax:
Practice Address - Street 1:1101 E OCEAN AVE
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-7096
Practice Address - Country:US
Practice Address - Phone:805-735-8365
Practice Address - Fax:805-735-2604
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225200000X
CA2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer