Provider Demographics
NPI:1447683255
Name:GUMP, EDWARD PAUL JR (OTR/L)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:PAUL
Last Name:GUMP
Suffix:JR
Gender:M
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29377 RANCHO CALIFORNIA RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5206
Mailing Address - Country:US
Mailing Address - Phone:951-552-1126
Mailing Address - Fax:
Practice Address - Street 1:29377 RANCHO CALIFORNIA RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5206
Practice Address - Country:US
Practice Address - Phone:951-552-1126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-15
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8137225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist