Individual
DEBORAH A. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
710 S PAULINA ST, CHICAGO, IL 60612-3808
(312) 942-7173
(312) 942-5094
Mailing address
1036 BORDEN DR, ROSELLE, IL 60172-1706
(312) 942-7173
(312) 942-5094
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
IL
Other
Enumeration date
04/16/2007
Last updated
07/08/2007
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