BLAKE WALLACE

GERMANTOWN, TN
NPI1821617663
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy224Z00000X Occupational Therapy Assistant
(Licence: MS  TA3704)
Enumeration Date2020-04-12
Last Update Date2020-04-12
Business Address
MR. BLAKE WALLACE
7820 WALKING HORSE CIR
GERMANTOWN, TN 38138-2143
Phone number: 901-752-2500
Mailing Address
MR. BLAKE WALLACE
150 EVANSVILLE RD
COLDWATER, MS 38618-6778
Phone number: 662-561-5655
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