Individual
ERIN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTD, OTR/L
Contact information
Practice address
4339 NE 115TH AVE, PORTLAND, OR 97220-1409
(503) 882-0988
Mailing address
2130 SW CAMELOT CT APT 48, PORTLAND, OR 97225-3763
(678) 451-8676
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XM0800X
Mental Health Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
—
—
Other
Enumeration date
03/30/2022
Last updated
03/30/2022
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