Waller Occupational Therapy and Consulting, LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT003394 Issued in GA

Legal business name

WALLER OCCUPATIONAL THERAPY AND CONSULTING, LLC

Practice address

315 Christina CT
Macon, GA 31217-4528

Phone

(478) 755-0335

Fax

(478) 755-0335

NPI assigned

Feb 12, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Eulanda Lara Waller, OTR/LNPI 1073759619

Title

Owner

Phone

(478) 318-2313

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eulanda Lara Waller, OTR/L

  • Occupational Therapist
  • Macon, GA
  • NPI 1073759619
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1265932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265932800000",
    "number": "1003148289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "315 CHRISTINA CT",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312174528",
            "telephone_number": "478-755-0335",
            "fax_number": "478-755-0335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "315 CHRISTINA CT",
            "city": "MACON",
            "state": "GA",
            "postal_code": "312174528",
            "telephone_number": "478-755-0335",
            "fax_number": "478-755-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLER OCCUPATIONAL THERAPY AND CONSULTING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-12",
        "last_updated": "2010-02-12",
        "status": "A",
        "authorized_official_last_name": "WALLER",
        "authorized_official_first_name": "EULANDA",
        "authorized_official_middle_name": "LARA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "478-318-2313",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT003394",
            "primary": true
        },
        {
            "code": "225XE0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist, Environmental Modification",
            "state": "GA",
            "license": "OT003394",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Franc Wallace, MD
• Heather E Wallace
• Lisa Marie Wallace, CRNA
• William Wallace Jr., MD
• Ryan C. Wallentine, PA-AA
• Eulanda Lara Waller, OTR/L
• Laura B Walsh, LPC
• Heather Michele Walters, PHARMD
• David T Wang, D.O.
• Gang G Wang, DMD

• Occupational Therapist in Macon, GA
• Providers in Macon, GA by specialty
• Occupational Therapist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.