Individual
MISS DAWN MICHELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
97 HUGHES RD STE H, MADISON, AL 35758-3401
(256) 883-7338
Mailing address
97 HUGHES RD STE H, MADISON, AL 35758-3401
(256) 883-7338
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
0754
AL
Other
Enumeration date
01/30/2008
Last updated
11/30/2010
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