National Provider Identifier
Tracey Wallace, OT
Tracey Wallace, OT is listed in the NPPES registry with a primary specialty of Occupational Therapist in Canandaigua, NY and a listed phone number of (585) 394-9510.
Source: public NPPES record, last updated January 22, 2014. This profile is informational and is not medical advice, a quality rating, or a provider recommendation.
Profile Overview
- NPI
- 1770638165
- Provider Type
- Individual
- Primary Specialty
- Occupational Therapist
- Enumeration Date
- January 24, 2007
- Last Updated
- January 22, 2014
Practice Location
- 5415 N Bloomfield RD
- Canandaigua, NY 14424-7964
Phone: (585) 394-9510
Specialties
- Occupational Therapist (225X00000X)
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Biography
The NPPES record for Tracey Wallace, OT lists Occupational Therapist as the primary taxonomy and Canandaigua, NY as the practice location.
Full Record
- NPI
- 1770638165
- Entity Type
- Individual
- Last Name
- Wallace
- First Name
- Tracey
- Credential
- OT
- Provider Other Last Name
- O'Donnell
- Provider Other First Name
- Tracey
- Provider Other Middle Name
- Erin
- Provider Other Last Name Type Code
- 1
- Mailing Street Address
- 5415 N Bloomfield RD
- Mailing City
- Canandaigua
- Mailing State
- NY
- Mailing ZIP Code
- 14424-7964
- Mailing Country
- US
- Mailing Phone
- (585) 394-9510
- Mailing Fax
- (585) 394-5326
- Practice Street Address
- 5415 N Bloomfield RD
- Practice City
- Canandaigua
- Practice State
- NY
- Practice ZIP Code
- 14424-7964
- Practice Country
- US
- Practice Phone
- (585) 394-9510
- Practice Fax
- (585) 394-5326
- Enumeration Date
- January 24, 2007
- Last Updated
- January 22, 2014
- Sex
- Female
- Sole Proprietor
- No
- Taxonomies
- Occupational Therapist (225X00000X)
- Other Identifiers
- 23389338 (NM)