Individual
ELI WILLIAM WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT
Contact information
Practice address
400 POLLY LN, LAFAYETTE, LA 70508-4966
(337) 443-0652
Mailing address
105 CONCERTO CRST, DUSON, LA 70529-3352
(337) 258-5264
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OTT.200733
LA
Other
Enumeration date
06/17/2024
Last updated
06/17/2024
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