Individual
SUSAN K WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
30 SPRINGCREST CT, GREENVILLE, SC 29607-4034
(864) 528-5547
(864) 528-5541
Mailing address
1214 SHADOW WAY, GREENVILLE, SC 29615-3843
(864) 297-8526
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2623
SC
Other
Enumeration date
05/13/2010
Last updated
05/13/2010
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