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Individual

SHAUNA WALLACE

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR

Contact information

Practice address
N14463 HIGHWAY 53, MINONG, WI 54859-9483
(715) 466-2297
Mailing address
716 STIGNEY ST, MINONG, WI 54859-8001
(715) 558-3725

Taxonomy

Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
4861-27
WI
225X00000X
Occupational Therapist
Primary
6369-26
WI

Other

Enumeration date
08/12/2015
Last updated
09/21/2018
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