Noreen Wallace, OTR L
Individual provider Active NPI Occupational Therapist · Woodstock, CT
NPI 1366518771 · NPPES record last updated Sep 19, 2011
Key facts
- NPI
- 1366518771
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Occupational Therapist 225X00000X
- License
- 00042 (CT)
- Practice address
- 602 Rte 169
Woodstock, CT 06281 - Phone
- (860) 963-0712
- Fax
- (860) 963-0712
- NPI assigned
- Nov 28, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00042 | CT | MD | Occupational Therapist |
| 000442 | CT | MD | Physician Assistant |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 00042 | CT | Yes |
Addresses
Primary practice location
602 Rte 169
Woodstock, CT 06281
Mailing address
PO Box 397
Woodstock, CT 06281
Phone (860) 963-0712
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2V8290 | Other | ORTHONET | |
| 747741 | Other | CONNECTICARE | |
| P815837 | Other | OXFORD | |
| 130000442CT01 | Other | ANTHEM BLUE CROSS BLUE SH | |
| 2957257 | Other | AETNA | |
| OV7803 | Other | HEALTHNET |
Other providers in Woodstock, CT
- William Shevin
- Laurie Lee Swenson
- Janel M Syriac
- Therapeutic Enterprises Inc.
- Jaidyn Avery Varin
- Paige Westerfield
- Woodstock Public Schools
- Woodstock Volunteer Fire Assoc Inc
- Robert Wayman Worsham
- Lindsay Jean Young
All providers in Woodstock, CT · Occupational Therapist in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.