Taylor Wallace, COTA/L

NPI 1386410850 · on the registry since 2023 · sole proprietor

Practice

Address: 148 W State St Ste 103
Kennett Square, PA 19348
Phone: (484) 432-1614
Organisation at this address: Diamond State Advisory, Llc
Bloom And Grow Early Intervention Llc
Diakon Child Family & Community Ministries
Inferred from a shared address, not stated in the registry.
Clinicians at this address: 2

Registry record

Primary taxonomy: 224Z00000X
224Z00000X
Licence states on file: PA
From the registry's licence fields, which are often incomplete.
Sex: Female
Record last updated: 2023-11-27

Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Pennsylvania