Individual
TAYLOR WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
148 W STATE ST STE 103, KENNETT SQUARE, PA 19348-3055
(484) 432-1614
Mailing address
700 CHERRY TREE RD APT G2, UPPER CHICHESTER, PA 19014-2450
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP009719
PA
Other
Enumeration date
11/27/2023
Last updated
11/27/2023
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