Individual
DIANA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
1207 N 33RD ST, RENTON, WA 98056-1943
(425) 255-5465
Mailing address
1207 N 33RD ST, RENTON, WA 98056-1943
(425) 255-5465
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT 00001911
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT 00001911
OCCUPATIONAL THERAPIST LICENSE
WA
Enumeration date
04/27/2015
Last updated
04/27/2015
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