Individual
JANELLE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA/L
Contact information
Practice address
620 HOWARD AVE, ALTOONA, PA 16601
(814) 889-2011
Mailing address
620 HOWARD AVE, ALTOONA, PA 16601
(814) 762-9102
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
OP009615
PA
Other
Enumeration date
04/16/2019
Last updated
03/31/2021
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