Individual
MRS. SUSAN MARIE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.T.R.
Contact information
Practice address
355 OAK GROVE RD, SPARTANBURG, SC 29301-2537
(864) 595-4225
Mailing address
15 WYNDHAVEN CT, SIMPSONVILLE, SC 29681-5289
(864) 297-0014
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
539
SC
Other
Enumeration date
11/18/2008
Last updated
11/18/2008
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