| NPI | 1285188037 |
|---|---|
| Former Name | JANELLE A WALLACE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225X00000X Occupational Therapist (Licence: WI 4330-26) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: MN 104796) |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2016-08-10 |