Individual
GERALYN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
110 N MAIN ST, GREENVILLE, PA 16125-1726
(724) 588-2100
Mailing address
369 S KEEL RIDGE RD, HERMITAGE, PA 16148-3508
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OC010198
PA
Other
Enumeration date
07/13/2010
Last updated
07/13/2010
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