Individual
MR. TYLER LEE WALLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OTR/L
Contact information
Practice address
1500 PROVIDENT DR, WARSAW, IN 46580-3297
(574) 371-2500
Mailing address
1405 BRUBAKER ST, WARSAW, IN 46580-2908
(574) 453-6544
Taxonomy
Speciality
Code
Description
License number
State
225XP0019X
Physical Rehabilitation Occupational Therapist
Primary
31004893A
IN
Other
Enumeration date
08/27/2010
Last updated
08/27/2010
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