Taylor Montana Wallace
NPI #1255165189 in Tishomingo, Oklahoma
Provider Information
- NPI Number
- 1255165189
- Entity Type
- Individual
- Name
- Taylor Montana Wallace
- Gender
- Not Specified
- Sole Proprietor
- Yes
- Primary Specialty
- Case Manager/Care Coordinator
- Enumeration Date
- Sep 2, 2024
- Last Updated
- Sep 2, 2024
Practice Location
- Address
- 602 E 24TH ST
- City
- Tishomingo
- State
- Oklahoma
- ZIP Code
- 73460-3245
- Phone
- (316) 312-2085
Specialties & Taxonomy Codes
| Specialty |
|---|
| Case Manager/Care Coordinator |
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