| Ms Leslie Ann Wallace, OT | |
|
43922 Canal Rd, Ronan, MT 59864-9192 | |
| (406) 676-2912 | |
| (406) 676-2912 |
| Full Name | Ms Leslie Ann Wallace |
|---|---|
| Gender | Female |
| Speciality | Occupational Therapist - Pediatrics |
| Location | 43922 Canal Rd, Ronan, Montana |
| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750444956 | NPI | - | NPPES |
| 0341343 | Medicaid | MT | |
| 66351 | Other | MT | BCBS PROVIDER NUMBER |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 225X00000X | Occupational Therapist | 186 (Montana) | Primary |
| 225XP0200X | Occupational Therapist - Pediatrics | 186 (Montana) | Primary |
| Mailing Address | Practice Location Address |
|---|---|
| Ms Leslie Ann Wallace, OT 43922 Canal Rd, Ronan, MT 59864-9192 Ph: (406) 676-2912 | Ms Leslie Ann Wallace, OT 43922 Canal Rd, Ronan, MT 59864-9192 Ph: (406) 676-2912 |
Ms. Shannon Marie Harris, MOTR/L Occupational Therapist Medicare: Accepting Medicare Assignments Practice Location: 107 6th Ave Sw, Ronan, MT 59864 Phone: 406-676-4441 | |
Mrs. Taylor E Johnson, OTD Occupational Therapist Medicare: Medicare Enrolled Practice Location: 107 6th Ave Sw, Ronan, MT 59864 Phone: 406-676-4441 Fax: 406-676-0835 |