Wallace, Patricia Ann
Wallace, Patricia Ann is an individual health care provider with primary practice located at 5949 W Raymond St , Indianapolis IN 46241-4348. 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, Patricia Ann can be contacted via phone (317) 247-1579.Contact Information
Primary practice address
5949 W Raymond St
Indianapolis IN 46241-4348
Phone: (317) 247-1579
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | 31000396A | Indiana |
Profile Details
| NPI number | 1851354492 |
|---|---|
| LBN Legal business name | Wallace, Patricia Ann |
| Credentials | Occupational Therapist (OT) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 6th, 2006 |
| Last updated | Aug 5th, 2013 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1851354492 | NPPES |
| Indiana | Other | 000000355350 | ANTHEM ID |
| Indiana | MEDICAID | 200515660 | ANTHEM ID |
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