Individual
MRS. KELLI WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
2701 T P WHITE DR, JACKSONVILLE, AR 72076-2514
(501) 241-0410
(501) 241-0125
Mailing address
2701 T P WHITE DR, JACKSONVILLE, AR 72076-2514
(501) 241-0410
(501) 241-0125
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OT-A969
AR
Other
Enumeration date
04/20/2015
Last updated
04/20/2015
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