Kristen Wallace, COTA

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

301141 Issued in LA

Practice address

1605 Stubbs Ave
Monroe, LA 71201-5629

Phone

(318) 388-8414

Fax

(318) 388-8558

NPI assigned

Jun 27, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Building Futures

  • Speech-Language Pathologist
  • Monroe, LA
  • NPI 1770672073
  NPD (past)

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

{
    "created_epoch": "1719446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719446400000",
    "number": "1013752450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 STUBBS AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015629",
            "telephone_number": "318-388-8414",
            "fax_number": "318-388-8558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 STUBBS AVE",
            "city": "MONROE",
            "state": "LA",
            "postal_code": "712015629",
            "telephone_number": "318-388-8414",
            "fax_number": "318-388-8558"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1603 Goodwin Rd",
            "address_purpose": "LOCATION",
            "city": "Ruston",
            "state": "LA",
            "postal_code": "712702907",
            "country_code": "US",
            "telephone_number": "318-255-7550",
            "fax_number": "318-255-7552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "KRISTEN",
        "credential": "COTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-06-27",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "LA",
            "license": "301141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Wayne Walker, DDS
• Miesha S Walker
• Naomi L Walker
• Rosie Michelle Walker
• Zanee Walker, MS
• Latrenda Davis Wallace, MHS
• Paula M. Wallace, P.A.
• Suhan Wallace, M.A.
• Tara Ezell Wallace, OTA
• Victoria Wallace, LCSW

• Occupational Therapy Assistant in Monroe, LA
• Providers in Monroe, LA by specialty
• Occupational Therapy Assistant in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.