Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Edwin Gultom, COTA

Individual provider Occupational Therapy Assistant · NPI 1316256084

Edwin Gultom, COTA is an Occupational Therapy Assistant in Victorville, California. Licensed in California. Registered with an NPI since 2010.

Licensed in
CA
In the registry since
2010
What do these letters mean?
COTA — Certified Occupational Therapy Assistant
Delivers treatment under an occupational therapist's direction.

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Practice location Address checks out

16890 Green Tree Blvd
Victorville, CA 92395-5618
Phone: (760) 245-5361
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence 2010 (CA)

Record details

NPI number1316256084
Entity typeIndividual (Type 1)
GenderMale
Credentials COTA
Sole proprietorNo
NPI enumeratedSeptember 29, 2010
Last updated in NPPESSeptember 29, 2010

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