Individual
MRS. STEPHANIE R WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
5626 LASATER DR NW APT 5, CANTON, OH 44718-1923
(330) 313-7702
Mailing address
5626 LASATER DR NW APT 5, CANTON, OH 44718-1923
(330) 313-7702
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OTA.03561
OH
Other
Enumeration date
11/27/2007
Last updated
11/27/2007
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