Individual
JENNILYN AVA WALLING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2300 PAVILION DR, KINGSPORT, TN 37660-4622
(423) 765-9655
Mailing address
3016 MABE STANLEYTOWN RD, DUFFIELD, VA 24244-4614
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
0131002877
VA
224Z00000X
Occupational Therapy Assistant
Primary
4108
TN
Other
Enumeration date
08/18/2025
Last updated
08/18/2025
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