Individual
LATONIA T WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
577 STABLE ST, PATASKALA, OH 43062-7066
(380) 997-9972
Mailing address
577 STABLE ST, PATASKALA, OH 43062-7066
(380) 997-9972
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
—
—
253Z00000X
In Home Supportive Care Agency
Primary
—
—
376J00000X
Homemaker
—
—
385H00000X
Respite Care
—
—
Other
Enumeration date
11/09/2023
Last updated
07/31/2024
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