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NPI Code Detail

MEDICARE: KRISTEN WALLACE OT

MEDICARE: KRISTEN WALLACE OT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225X00000XOccupational Therapist01326

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1538297544
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN WALLACE OT
Provider Business Mailing Address
First Line : 1200 CORPORATE DR STE 400
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35242-5424
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5959 CORSON AVE S
Second Line :
City : SEATTLE
State : WA
Zip : 98108-2605
Country : US
Telephone Number : 206-971-7466
Fax Number : 206-971-7515
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/01/2007
Last Update Date : 04/06/2018

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