Wallace, Nancy Ann

Wallace, Nancy Ann is an sole proprietor health care provider with primary practice located at 2909 Friendship Rd , Paragould AR 72450-7548. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant, which is considered as her primary health care specialty. Wallace, Nancy Ann can be contacted via phone (601) 624-2618.

Contact Information

Primary practice address
2909 Friendship Rd Paragould AR 72450-7548
Phone: (601) 624-2618
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapy Assistant 224Z00000X OT1220 Arkansas

Profile Details

NPI number 1669717211
LBN Legal business name Wallace, Nancy Ann
Credentials Certified Occupational Therapy Assistant (COTA)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 10th, 2012
Last updated Dec 10th, 2012 - about 12 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 1669717211 NPPES
Arkansas MEDICAID 194418721

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