Individual
LUCAS WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
57 FAIRVIEW AVE, SKOWHEGAN, ME 04976-1414
(207) 474-7000
(207) 858-4772
Mailing address
PO BOX 468, SKOWHEGAN, ME 04976-0468
(207) 474-7000
(207) 858-4772
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT4044
ME
Other
Enumeration date
01/04/2022
Last updated
07/03/2023
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