Raymond M Wallace, COTA/L

NPI #1003490228 in Broken Arrow, Oklahoma

Provider Information

NPI Number
1003490228
Entity Type
Individual
Name
Raymond M Wallace, COTA/L
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Occupational Therapy Assistant
Credential
COTA/L
Enumeration Date
May 12, 2021
Last Updated
May 12, 2021

Practice Location

Address
6956 S 310TH EAST AVE
ZIP Code
74014-5491
Phone
(918) 230-8099

Specialties & Taxonomy Codes

Specialty
Occupational Therapy Assistant

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