Individual
TRACI WALLACE L WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6612 LOVELL CT, DAYTON, OH 45424-7120
(937) 361-9726
Mailing address
6612 LOVELL CT, DAYTON, OH 45424-7120
(937) 361-9726
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
OH
Other
Enumeration date
10/29/2025
Last updated
10/29/2025
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