Individual
MS. EULANDA LARA WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
315 CHRISTINA CT, MACON, GA 31217-4528
(478) 318-2313
(478) 755-0335
Mailing address
315 CHRISTINA CT, MACON, GA 31217-1331
(478) 318-2313
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT003394
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
874780070A
—
GA
Enumeration date
01/04/2009
Last updated
02/28/2013
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