Individual
NICOLE WALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3000 N STATE RD 135, GREENWOOD, IN 46143
(800) 777-7775
Mailing address
910 N DEQUINCY ST, INDIANAPOLIS, IN 46201-2844
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
225XN1300X
Neurorehabilitation Occupational Therapist
—
—
Other
Enumeration date
01/05/2022
Last updated
01/05/2022
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