Individual
DANIELLE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5021 MERCER UNIVERSITY DR, MACON, GA 31210-5691
(478) 845-3520
(478) 845-3520
Mailing address
PO BOX 1552, BYRON, GA 31008-1552
(478) 845-3520
(478) 956-0401
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT005020
GA
Other
Enumeration date
06/29/2017
Last updated
06/29/2017
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