Edwin Gultom, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

2010 Issued in CA

Practice address

16890 Green Tree Blvd
Victorville, CA 92395-5618

Phone

(760) 245-5361

NPI assigned

Sep 29, 2010

Last updated

Sep 29, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1285718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285718400000",
    "number": "1316256084",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "906 KENSINGTON DR",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923744927",
            "telephone_number": "909-255-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16890 GREEN TREE BLVD",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923955618",
            "telephone_number": "760-245-5361"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULTOM",
        "first_name": "EDWIN",
        "credential": "COTA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-29",
        "last_updated": "2010-09-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "CA",
            "license": "2010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Isabelle Guiang, MSN, CPN, NP-C
• Adriana Guillen
• Trina Marie Guillen
• Anthony Guinn
• Pushpinder S Guleria, M.D.
• Megha Nayyar Gupta, MD
• Nikhil Gupta, M.D.
• Miranda Roxanne Guthrie
• Angela Gutierrez
• Gavin R Gutierrez

• Occupational Therapy Assistant in Victorville, CA
• Providers in Victorville, CA by specialty
• Occupational Therapy Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.