Tara Wallace, LMT, MMP

NPI #1790124378 in O Fallon, Missouri

Provider Information

NPI Number: 1790124378
Entity Type: Individual
Name: Tara Wallace, LMT, MMP
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Specialist
Credential: LMT, MMP
Enumeration Date: Jun 18, 2013
Last Updated: Jun 18, 2013

Practice Location

Address: 2633 BABBLE CREEK LN
City: O Fallon
State: Missouri
ZIP Code: 63368-8338
Phone: (636) 577-1216

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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