Eulanda Lara Waller, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OT003394 Issued in GA

Practice address

315 Christina CT
Macon, GA 31217-4528

Phone

(478) 318-2313

Fax

(478) 755-0335

NPI assigned

Jan 4, 2009

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Waller Occupational Therapy and Consulting, LLC

  • Occupational Therapist
  • Macon, GA
  • NPI 1003148289
  Medicare reassignment Authorized official
• Daily Grace Adult Day Health Services, Inc

  • Adult Day Care Clinic/Center
  • Macon, GA
  • NPI 1861937443
  NPD (past) Authorized official
• Integra Rehabilitation Agency, LLC

  dba Integra Rehab Agency

  • Rehabilitation Clinic/Center
  • Dalton, GA
  • NPI 1053414177
  NPD (past)

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

{
    "created_epoch": "1231027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362009600000",
    "number": "1073759619",
    "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": "312171331",
            "telephone_number": "478-318-2313"
        },
        {
            "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": "478-318-2313",
            "fax_number": "478-755-0335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "EULANDA",
        "middle_name": "LARA",
        "name_prefix": "Ms.",
        "credential": "OTR/L",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-01-04",
        "last_updated": "2013-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "GA",
            "license": "OT003394",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "874780070A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather E Wallace
• Lisa Marie Wallace, CRNA
• William Wallace Jr., MD
• Ryan C. Wallentine, PA-AA
• Waller Occupational Therapy and Consulting, LLC
• Laura B Walsh, LPC
• Heather Michele Walters, PHARMD
• David T Wang, D.O.
• Gang G Wang, DMD
• Jade Wang

• 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 28, 2013; 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.