Individual
TRACY DAWN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, OTR/L
Contact information
Practice address
1290 LAWRENCE STATION RD, SUNNYVALE, CA 94089-2220
(408) 743-5332
Mailing address
97 NORMANDY LN, ATHERTON, CA 94027-3816
(650) 380-9483
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
8081
CA
Other
Enumeration date
11/20/2017
Last updated
11/20/2017
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