MR. Charles Wallace Wickliffe is a recreation therapist in Los Angeles, CA. The provider is a recreation therapist uses recreational activities for intervention in some physical, social or emotional behavior to bring about a desired change in that behavior and promote the growth and development of the patient. MR. Charles Wallace Wickliffe NPI is 1871663054. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
11301 WILSHIRE BLVD
117R
LOS ANGELES, CA
ZIP 90073-003
Phone: (310) 478-3711
The enumeration date for this NPI number is 11/8/2006 and was last updated on 7/8/2007.