Angela Suzanne Wallace, OTD, M.ED., OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT23936 Issued in FL

Practice address

1808 Medart Dr
Tallahassee, FL 32303-3420

Phone

(850) 909-5521

Fax

(850) 391-4178

NPI assigned

Feb 14, 2023

Sex

Female

Sole proprietor

No

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

Credentials

Master of Education

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.

• Sunny Speech Inc

  • Speech-Language Pathologist
  • Tallahassee, FL
  • NPI 1841798618

  Occupational Therapist

  NPD (past)

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

{
    "created_epoch": "1676332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677628800000",
    "number": "1073210522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 MEDART DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323033420",
            "telephone_number": "850-909-5521",
            "fax_number": "850-391-4178"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1808 MEDART DR",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323033420",
            "telephone_number": "850-909-5521",
            "fax_number": "850-391-4178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ANGELA",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "OTD, M.ED., OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-14",
        "last_updated": "2023-03-01",
        "certification_date": "2023-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "FL",
            "license": "OT23936",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tranesia Monique Walker, LCSW
• William Walker
• William Tyler Walker
• Angela Wallace Chatfield, LCSW
• Alexandra Wallace
• Jay William Wallace, PHARM. D.
• Mervin P Wallace, MD
• Tangela Wallace, LPTA
• Kayla Renae Waller, FNP-C
• Wesley Waller

• Occupational Therapist in Tallahassee, FL
• Providers in Tallahassee, FL by specialty
• Occupational Therapist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2023; 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.