Leonarda Wallace, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

7629418 Issued in NY

Practice address

218 Edgegrove Ave
Staten Island, NY 10312-3512

Phone

(718) 873-7713

NPI assigned

Nov 17, 2011

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

State licenses

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

{
    "created_epoch": "1321488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1455235200000",
    "number": "1174890396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "218 EDGEGROVE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123512",
            "telephone_number": "718-873-7713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 EDGEGROVE AVE",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103123512",
            "telephone_number": "718-873-7713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LEONARDA",
        "name_prefix": "Mrs.",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-11-17",
        "last_updated": "2016-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NY",
            "license": "7629418",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia L Wallace, THERAPIST
• Delaney Wallace
• Jessica Wallace
• Jessica Lorraine Wallace, PA
• Kevin Gary Wallace, PHARMD.
• Michael Wallace II
• Thomas E Wallace III, PHARMD
• Edward S Wallach, LCSW, PH.D.
• Stefanie Wallin
• Kathleen Walsh-Hoey, MA, CCC-SLP

• Occupational Therapist in Staten Island, NY
• Providers in Staten Island, NY by specialty
• Occupational Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2016; 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.