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1649667353
KELLI WALLACE
JACKSONVILLE, AR
NPI
1649667353
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
224Z00000X Occupational Therapy Assistant
(Licence: AR OT-A969)
Enumeration Date
2015-04-20
Last Update Date
2015-04-20
Business Address
Mrs. KELLI WALLACE COTA
2701 T P WHITE DR
JACKSONVILLE, AR 72076-2514
Phone number: 501-241-0410
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Mailing Address
Mrs. KELLI WALLACE COTA
2701 T P WHITE DR
JACKSONVILLE, AR 72076-2514
Phone number: 501-241-0410
Copy
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