Individual
KRISTIN WALLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
45 E LOCKWOOD AVE, WEBSTER GROVES, MO 63119-3050
(314) 918-7300
Mailing address
705 KINGFISHER LN APT I, WOODBURY, MN 55125-1850
(414) 350-7070
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
104627
MN
225X00000X
Occupational Therapist
2011035655
MO
225X00000X
Occupational Therapist
4024
WI
Other
Enumeration date
06/16/2006
Last updated
05/26/2014
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