IndividualActive
Charles Wickliffe
NPI 1871663054 · Recreation Therapist · Los Angeles, CA
Provider details
- NPI number
- 1871663054
- Entity type
- Individual
- Primary specialty
- Recreation TherapistRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Male
- Sole proprietor
- Yes
Practice location
11301 Wilshire Blvd
117r
Los Angeles, CA 90073-1003
Phone: (310) 478-3711
Mailing address
5274 Parkglen Ave
Los Angeles, CA 90043-1030
Registry dates
- Enumerated
- 2006-11-08
- Last updated
- 2007-07-08
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.