Individual
GRACE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2210 W DALLAS ST APT 1522, HOUSTON, TX 77019-4356
(781) 626-3729
Mailing address
2210 W DALLAS ST APT 1522, HOUSTON, TX 77019-4356
(781) 626-3729
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
215123
TX
Other
Enumeration date
08/12/2018
Last updated
08/12/2018
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