Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 0119001250 | VA |
NPI | 1033256029 |
---|---|
Provider Name | Michelle Wallace Allen |
First Address | Midlothian, VA 23113-4033 |
Second Address | Midlothian, VA 23113-3662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/01/2007 |
Last Update Date | 08/07/2007 |