Individual
KELSI NOELLE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OT
Contact information
Practice address
2300 RAMSEY ST, FAYETTEVILLE, NC 28301-3856
(910) 488-2120
Mailing address
1218 HAYES RD, SPRING LAKE, NC 28390-8018
(812) 701-5602
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
—
—
Other
Enumeration date
01/04/2024
Last updated
01/04/2024
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