Individual
PATRICIA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1755 WITTINGTON PL STE 175, DALLAS, TX 75234-1905
(866) 221-5405
Mailing address
8994 COUNTY ROUTE 13, BATH, NY 14810-7916
(607) 684-8783
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
4664
SC
Other
Enumeration date
01/25/2017
Last updated
01/25/2017
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