Individual
KATELYN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 GOFFS FALLS RD, STE 101, MANCHESTER, NH 03111-1000
(800) 995-2673
(888) 979-6551
Mailing address
3000 GOFFS FALLS RD, STE 101, MANCHESTER, NH 03111-1000
(800) 995-2673
(888) 979-6551
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
0119006994
VA
Other
Enumeration date
01/10/2017
Last updated
01/10/2017
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