Individual
LAURA STEWART WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1 PARK AVE, SUITE F, MOUNT AIRY, MD 21771-5437
(301) 607-8383
(301) 829-8640
Mailing address
1 PARK AVE, SUITE F, MOUNT AIRY, MD 21771-5437
(301) 607-8383
(301) 829-8640
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
01641
MD
Other
Enumeration date
10/01/2007
Last updated
10/01/2007
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