Individual
KELSEY MARIE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTD
Contact information
Practice address
1017 MYSTIC DR, MOUNT PLEASANT, SC 29464-2793
(646) 465-0540
Mailing address
356 WOODLAND SHORES RD, CHARLESTON, SC 29412-2423
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
7168
SC
Other
Enumeration date
08/05/2025
Last updated
08/05/2025
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