Raymond M Wallace
Occupational Therapy Assistant
6956 S 310th East Ave
Broken Arrow
, Oklahoma 74014-5491
Raymond M Wallace
Occupational Therapy Assistant
6956 S 310th East Ave
Broken Arrow
, Oklahoma 74014-5491
(918) 230-8099
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About
Features
Specialties
- Occupational Therapy Assistant
Languages spoken
- English
Location
First Address
- Raymond M Wallace
- 6956 S 310th East Ave
- Broken Arrow, OK
- Zip : 74014-5491
- Phone : (918) 230-8099
Second Address
- Raymond M Wallace
- 6956 S 310th East Ave
- Broken Arrow, OK
- Zip : 74014-5491
- Phone : (918) 230-8099
Reviews
FAQs
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What type of doctor is Raymond M Wallace
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 224Z00000X | Occupational Therapy Assistant | 569 | OK |
National Provider Identifier
| NPI | 1003490228 |
|---|---|
| Provider Name | Raymond M Wallace |
| First Address | Broken Arrow, OK 74014-5491 |
| Second Address | Broken Arrow, OK 74014-5491 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 12/05/2021 |
| Last Update Date | 12/05/2021 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.