Individual
MRS. COLLEEN THERESE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
COTA
Contact information
Practice address
9286 ARPIN RICHFIELD RD, ARPIN, WI 54410-9514
(715) 897-4213
Mailing address
9286 ARPIN RICHFIELD RD, ARPIN, WI 54410-9514
(715) 897-4213
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1032-27
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1032-27
—
WI
Enumeration date
01/21/2013
Last updated
01/21/2013
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