Individual
JENNIFER NICOLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
69 DEANE RD, RUCKERSVILLE, VA 22968-3482
(434) 481-3524
Mailing address
69 DEANE RD, RUCKERSVILLE, VA 22968-3482
(434) 481-3524
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0131002787
VA
Other
Enumeration date
12/01/2022
Last updated
12/01/2022
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