Individual
BROOKE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LOT
Contact information
Practice address
505 N SAM HOUSTON PKWY E, 200, HOUSTON, TX 77060-4018
(817) 274-1200
(817) 274-1299
Mailing address
505 N SAM HOUSTON PKWY E, 200, HOUSTON, TX 77060-4018
(817) 274-1200
(817) 274-1299
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
101163
TX
Other
Enumeration date
01/18/2010
Last updated
01/18/2010
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