Individual
TARA EZELL WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTA
Contact information
Practice address
2301 STERLINGTON RD, MONROE, LA 71203-3045
(318) 323-3426
Mailing address
2301 STERLINGTON RD, MONROE, LA 71203-3045
(318) 323-3426
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.200015
LA
Other
Enumeration date
08/18/2025
Last updated
08/18/2025
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