Individual
DORIAN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT/R
Contact information
Practice address
2 RIVERSIDE CIR, ROANOKE, VA 24016-4950
(540) 520-7154
Mailing address
2 RIVERSIDE CIR, ROANOKE, VA 24016-4950
(540) 520-7154
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
225XP0200X
Pediatric Occupational Therapist
Primary
0119005945
VA
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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