Individual
FALLON WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
22822 MYRTLE ST, HAYWARD, CA 94541-6321
(510) 537-4844
Mailing address
342 LYNDA LN, LEXINGTON, NC 27295-7948
(336) 239-1465
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA4830
CA
Other
Enumeration date
10/01/2019
Last updated
10/01/2019
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