Individual
AMY ANN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR-L
Contact information
Practice address
10539 PROFESSIONAL CIR, SUITE 201, SOUTH LAKE TAHOE, CA 96150-3828
(775) 348-8800
(833) 687-1419
Mailing address
PO BOX 9578, SOUTH LAKE TAHOE, CA 96158
(530) 543-5896
(530) 544-6512
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0721
NV
225X00000X
Occupational Therapist
3665
CA
Other
Enumeration date
12/27/2006
Last updated
07/24/2023
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