MEDICARE: AMY ANN WALLACE OTR-L

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
1	225X00000X	Occupational Therapist	3665	CA
2	225X00000X	Occupational Therapist	0721	NV

General Provider Information

NPI Number	:	1467517466
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY ANN WALLACE OTR-L

Provider Business Mailing Address
First Line	:	PO BOX 9578
Second Line	:
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96158
Country	:	US
Telephone Number	:	530-543-5896
Fax Number	:	530-544-6512

Provider Business Practice Location Address
First Line	:	10539 PROFESSIONAL CIR
Second Line	:	SUITE 201
City	:	SOUTH LAKE TAHOE
State	:	CA
Zip	:	96150-3828
Country	:	US
Telephone Number	:	775-348-8800
Fax Number	:	833-687-1419

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	07/24/2023

Similar Medicare Providers

1366694812 — LUISA EDITH TODD M.D.
Practice Location Address:

1017 E 600 S
SALT LAKE CITY, UT
84102-3828

Practice Phone: 801-879-1002
Practice Fax:

1902160740 — MISS MAHALIA A DINZEY MHC, MFT, CMHP
Practice Location Address:

3828 E LAKE PL
MIRAMAR, FL
33023-4936

Practice Phone: 954-613-5957
Practice Fax:

1235536483 — MS. EYVONNE JACSKON LVN
Practice Location Address:

507 ELLIS ST
LAKE ELSINORE, CA
92530-3828

Practice Phone: 951-491-4907
Practice Fax:

1255729703 — BRIANNA L COALE MS ED, BCBA, LBA
Practice Location Address:

3828 SOUTH AVE
SPRINGFIELD, MO
65807-5285

Practice Phone: 417-414-7353
Practice Fax:

1760844765 — ZAYD NASHAAT M.D.
Practice Location Address:

3828 SOUTH 1ST STREET AUSTIN TX 78704-7048
AUSTIN, TX
78704-7048

Practice Phone: 512-443-1311
Practice Fax:

1558884973 — AMBER MARIE HAWKINS M.ED., BCBA, LBA
Practice Location Address:

3828 SOUTH AVE
SPRINGFIELD, MO
65807-5285

Practice Phone: 417-890-1399
Practice Fax:

Directions to “ AMY ANN WALLACE OTR-L” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.