Individual
MRS. KRISTIN NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., OTR
Contact information
Practice address
1506 S ONEIDA ST, APPLETON, WI 54915-1305
(920) 738-2000
Mailing address
2935 N RANKIN ST, APPLETON, WI 54911-1518
(920) 659-2887
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
12/06/2010
Last updated
12/06/2010
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