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Individual
NOREEN WALLACE
Active
Individual
NOREEN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR L
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
00042
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
130000442CT01
ANTHEM BLUE CROSS BLUE SH
—
01
—
2957257
AETNA
—
01
—
2V8290
ORTHONET
—
01
—
747741
CONNECTICARE
—
01
—
OV7803
HEALTHNET
—
01
—
P815837
OXFORD
—
Enumeration date
11/28/2006
Last updated
09/19/2011
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