Individual
JENNIFER J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
101 OKLAHOMA AVE, MCALESTER, OK 74501-7520
(580) 298-9818
(580) 298-9822
Mailing address
101 OKLAHOMA, MCALESTER, OK 74501-7520
(918) 421-3935
(918) 421-3939
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
632
OK
Other
Enumeration date
08/31/2009
Last updated
03/25/2021
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