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General NPI Number Information
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NPI Number | 1285896860
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Entity Type | Organization
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Legal Business Name | WALLACE THERAPY INC
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Dates
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Enumeration Date | 06/25/2008
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 9912 SPRING RIDGE DR
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City | LOUISVILLE
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State | KY
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Zip | 40223-2877
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Country | US
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Telephone | 502-442-4005
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Fax | 502-742-4469
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Provider Business Mailing Address
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Address Line | 9912 SPRING RIDGE DR
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City | LOUISVILLE
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State | KY
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Zip | 40223-2877
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Country | US
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Telephone | 502-442-4005
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Fax | 502-742-4469
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHERRELL K BAILEY
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Credential | MS CCC/SLP
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Telephone | 502-442-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number |
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License Number State | KY
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