Individual
MRS. RHONDA KAY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR/L
Contact information
Practice address
2031 AVONDALE ST, HUMBOLDT, TN 38343-1810
(731) 784-3655
(731) 784-3651
Mailing address
18 COTTON ROW, MEDINA, TN 38355-9810
(731) 437-0068
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
356
TN
Other
Enumeration date
12/01/2011
Last updated
12/01/2011
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