Individual
EMILY WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1445 E 10TH ST, COOKEVILLE, TN 38501-2017
(931) 372-2020
Mailing address
1445 E 10TH ST, COOKEVILLE, TN 38501-2017
(931) 372-2020
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
5614
TN
Other
Enumeration date
11/20/2018
Last updated
11/20/2018
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