Individual
MRS. TIARRA DANIELLE WALLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
21964 HIGHWAY 32, STE GENEVIEVE, MO 63670-9190
(573) 883-9366
(573) 883-9377
Mailing address
21964 HIGHWAY 32, STE GENEVIEVE, MO 63670-9190
(573) 883-9366
(573) 883-9377
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
2021006924
MO
Other
Enumeration date
05/16/2022
Last updated
05/16/2022
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