Individual
ANNA JOAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
255 59TH ST N, ST PETERSBURG, FL 33710-8539
(727) 345-2775
Mailing address
255 59TH ST N, ST PETERSBURG, FL 33710-8539
(727) 345-2775
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
12091
FL
Other
Enumeration date
02/08/2012
Last updated
02/08/2012
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