Wallace, Dana Jill
Wallace, Dana Jill is an individual health care provider with primary practice located at 20925 Professional Plaza Suite 300, Ashburn VA 20147. She recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Hand. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist is her primary health care specialty. Wallace, Dana Jill can be contacted via phone (703) 544-7171.Contact Information
Primary practice address
20925 Professional Plaza Suite 300
Ashburn VA 20147
Phone: (703) 544-7171
Fax: (703) 997-4450
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | OT004212 | Georgia |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Hand | 225XH1200X | ||
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | 0119005354 | Virginia |
Profile Details
| NPI number | 1073730636 |
|---|---|
| LBN Legal business name | Wallace, Dana Jill |
| Credentials | MS, OTR/L |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 18th, 2007 |
| Last updated | Aug 1st, 2023 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073730636 | NPPES |
| Other | 9519754 | AETNA | |
| Other | 976238-01 | AETNA | |
| Other | 4695-0050 | AETNA |
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