Organization
WALLER OCCUPATIONAL THERAPY AND CONSULTING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. EULANDA LARA WALLER OTR/L (OWNER)
(478) 318-2313
Entity
Organization
Contact information
Practice address
315 CHRISTINA CT, MACON, GA 31217-4528
(478) 755-0335
(478) 755-0335
Mailing address
315 CHRISTINA CT, MACON, GA 31217-4528
(478) 755-0335
(478) 755-0335
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003394
GA
225XE0001X
Environmental Modification Occupational Therapist
OT003394
GA
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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