Individual
MR. COREY WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2460 25TH ST NE, CANTON, OH 44705-2468
(330) 704-0134
Mailing address
2460 25TH ST NE, CANTON, OH 44705-2468
(330) 704-0134
Taxonomy
Speciality
Code
Description
License number
State
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
Primary
—
OH
Other
Enumeration date
06/27/2023
Last updated
06/27/2023
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