Individual
KRISTEN NICOLE WALLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
190 W SOUTH ST, HERNANDO, MS 38632-2245
(662) 298-0066
Mailing address
2284 FOGG RD, NESBIT, MS 38651-7409
(662) 404-0425
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT2815
MS
Other
Enumeration date
06/20/2013
Last updated
06/20/2013
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