Individual
MRS. TENA REED WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OTR, CHT
Contact information
Practice address
1 MEDICAL PARK BLVD, BRISTOL, TN 37620-7430
(423) 844-4144
(423) 844-4149
Mailing address
377 AUGUSTA DR, ABINGDON, VA 24211-3805
(423) 844-4144
(423) 844-4149
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
001862
TN
Other
Enumeration date
02/13/2007
Last updated
07/08/2007
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