Individual
WHITNEY R WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
303 N HURSTBOURNE PKWY, 200, LOUISVILLE, KY 40222-5185
(502) 412-5847
Mailing address
306 CRESTVIEW DR, OWENSVILLE, IN 47665-9258
(812) 677-0312
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
32002004A
IN
Other
Enumeration date
09/27/2012
Last updated
09/27/2012
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