Rebecca Wallace

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

590 Fishers Station Dr Ste 130
Victor, NY 14564-9744

Phone

(585) 924-7207

NPI assigned

Nov 8, 2021

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

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.

• Western New York Speech-Language Pathology, OT, and PT Consultants

  • Early Intervention Provider Agency
  • Victor, NY
  • NPI 1386812550

  Specialist

  NPD (past)

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

{
    "created_epoch": "1636329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636329600000",
    "number": "1083379705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 142",
            "city": "MENDON",
            "state": "NY",
            "postal_code": "145060142",
            "telephone_number": "585-355-9713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "590 FISHERS STATION DR STE 130",
            "city": "VICTOR",
            "state": "NY",
            "postal_code": "145649744",
            "telephone_number": "585-924-7207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "REBECCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-08",
        "last_updated": "2021-11-08",
        "certification_date": "2021-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Darlene S Vullo, M.A
• Brooke Leigh Wagner, LCSW
• Wal-Mart Stores East LP
• Kimberly Anne Walker, PMHNP
• Haley Elizabeth Wallace, OTR/L
• Andrea M Walsh, M.S.
• Warby Parker Inc.
• Karen L Ward, OTR
• Shannon Warden, M.S.
• Brooke Elizabeth Warren, M.S., CCC-SLP/L

• All providers in Victor, NY
• Specialist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.