Individual
JULIA DANIELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
1860 ATKINSON RD, LAWRENCEVILLE, GA 30043-5065
(706) 948-2773
Mailing address
110 PEARL ST SE APT 4, ATLANTA, GA 30316-1266
(404) 397-8655
Taxonomy
Speciality
Code
Description
License number
State
225XN1300X
Neurorehabilitation Occupational Therapist
Primary
OT008010
GA
Other
Enumeration date
10/21/2021
Last updated
10/21/2021
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