Individual
KATLIN D WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
599C STEED RD, RIDGELAND, MS 39157-1707
(601) 427-4111
Mailing address
599C STEED RD, RIDGELAND, MS 39157-1707
(601) 427-4111
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT-4069
MS
Other
Enumeration date
12/01/2023
Last updated
12/01/2023
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