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1174595367
BEVERLY WALLACE
BRADENTON, FL
NPI
1174595367
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
225X00000X Occupational Therapist
(Licence: FL OT9730)
Enumeration Date
2006-02-02
Last Update Date
2007-07-09
Business Address
Mrs. BEVERLY WALLACE OTR/L
3911 GOLF PARK LOOP SUITE #105
BRADENTON, FL 34203-3453
Phone number: 941-756-1003
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Mailing Address
Mrs. BEVERLY WALLACE OTR/L
6477 INDIGO BUNTING PL
BRADENTON, FL 34202-8246
Phone number: 941-756-1003
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