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General NPI Number Information
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NPI Number | 1043298425
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Entity Type | Organization
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Legal Business Name | WALLACE MANAGEMENT CORPORATION
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Dates
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Enumeration Date | 01/05/2006
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Last Update Date | 01/25/2017
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Provider Practice Location Address
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Address Line | 4175 STONERIDGE LANE
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City | DUBLIN
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State | OH
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Zip | 43017
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Country | US
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Telephone | 614-504-4733
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Fax | 440-498-9725
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Provider Business Mailing Address
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Address Line | 16600 SPRAGUE ROAD SUITE 365
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City | MIDDLEBURG HEIGHTS
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State | OH
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Zip | 44130
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Country | US
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Telephone | 216-227-7700
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Fax | 866-848-2496
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Authorized Official
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Title or Position | DIRECTOR
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Name | MARSHA A ZATCOFF
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Credential |
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Telephone | 864-244-3626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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