Individual
CLINTIN SPENCER WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
501 N MEDFORD DR, LUFKIN, TX 75901-5219
(936) 639-1252
Mailing address
11978 COUNTY ROAD 302, NACOGDOCHES, TX 75961-7687
(318) 235-2887
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
—
—
Other
Enumeration date
08/30/2018
Last updated
08/30/2018
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