Individual
CHRISTINA M WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7000 AUSTIN ST, FOREST HILLS, NY 11375-1022
(718) 762-7633
Mailing address
5 CARMINE DR, NETCONG, NJ 07857-1618
(862) 432-7327
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
010958
NY
Other
Enumeration date
01/31/2022
Last updated
01/31/2022
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