Individual
LISA JEAN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
480 SOMERSET ST UNIT 1, NORTH PLAINFIELD, NJ 07060-4018
(954) 292-3295
Mailing address
77 MADISON AVE, MORRISTOWN, NJ 07960-7330
(973) 540-9800
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
46TA09127800
NJ
Other
Enumeration date
05/28/2020
Last updated
05/28/2020
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