Wallace, Jennifer Lynn

Wallace, Jennifer Lynn is an individual health care provider with primary practice located at 340 E Jackson St , Gate City VA 24251-3526. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Wallace, Jennifer Lynn can be contacted via phone (276) 386-6118.

Contact Information

Primary practice address
340 E Jackson St Gate City VA 24251-3526
Phone: (276) 386-6118
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X

Profile Details

NPI number 1326541236
LBN Legal business name Wallace, Jennifer Lynn
Credentials OTR/L
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 16th, 2018
Last updated Mar 17th, 2018 - about 7 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1326541236 NPPES
Virginia Other 0119003062 VIRGINIA MEDICAL BOARD

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