Individual
MRS. DANA JILL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
20925 PROFESSIONAL PLAZA, SUITE 300, ASHBURN, VA 20147
(703) 544-7171
(703) 997-4450
Mailing address
20925 PROFESSIONAL PLAZA, SUITE 300, ASHBURN, VA 20147
(703) 544-7171
(703) 997-4450
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119005354
VA
225X00000X
Occupational Therapist
OT004212
GA
225XH1200X
Hand Occupational Therapist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4695-0050
CAREFIRST NCA
—
01
—
9519754
AETNA
—
01
—
976238-01
CAREFIRST MARYLAND
—
Enumeration date
04/18/2007
Last updated
08/01/2023
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