Individual
WHITNEY LEA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
624 PINEWOOD AVE, SEWARD, NE 68434-1055
(402) 643-2902
Mailing address
3721 FAULKNER DR APT 117, LINCOLN, NE 68516-4763
(308) 870-3193
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
1074
NE
Other
Enumeration date
03/01/2022
Last updated
03/01/2022
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