NPI 1003490228

Raymond M Wallace, COTAL

Practitioner Occupational Therapy Assistant Broken Arrow, OK

Practice location

Address: 6956 S 310th East Ave, Broken Arrow, OK 74014-5491
Phone: (918) 230-8099

Registered specialties

Occupational Therapy Assistant Primary

Respiratory, Developmental, Rehabilitative and Restorative Service Providers Taxonomy 224Z00000X Licence 569 (OK)

Other Occupational Therapy Assistant providers in Oklahoma →

Registry record

NPI: 1003490228
Entity type: Individual
Sex (as registered): Male
NPI issued: 12 May 2021
Record last updated: 12 May 2021

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.