Individual
MRS. KAITLIN JEAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
918 W BRUNDAGE LN, SHERIDAN, WY 82801-5827
(307) 673-4420
Mailing address
814 N CUSTER ST APT 102, SHERIDAN, WY 82801-3749
(818) 209-8709
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-1570
WY
Other
Enumeration date
07/27/2021
Last updated
07/27/2021
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