| Jonathan David Wallace, LOTR | |
|
870 Highway 516, Heflin, LA 71039-3726 | |
| (318) 614-5684 | |
| Not Available |
| Full Name | Jonathan David Wallace |
|---|---|
| Gender | Male |
| Speciality | Occupational Therapist |
| Location | 870 Highway 516, Heflin, Louisiana |
| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770219693 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | OTT.Z12243 (Louisiana) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Jonathan David Wallace, LOTR 870 Highway 516, Heflin, LA 71039-3726 Ph: () - | Jonathan David Wallace, LOTR 870 Highway 516, Heflin, LA 71039-3726 Ph: (318) 614-5684 |
Miss Amy Katina Litton, LOTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 4890 Highway 371, Heflin, LA 71039 Phone: 318-458-6014 | |
Mrs. Kimberly C Sumner, LOTR Occupational Therapist Medicare: Not Enrolled in Medicare Practice Location: 186 Art Camp Loop, Heflin, LA 71039 Phone: 318-377-6539 |