Brooke Wallace, COTA/L

Primary specialty

Occupational Therapy AssistantTaxonomy code 224Z00000X

License

OT-A1418 Issued in AR

Practice address

1699 Red Wolf Blvd
Jonesboro, AR 72401-5442

Phone

(870) 336-0021

NPI assigned

Oct 25, 2018

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

Other identifiers 1

Other names 1

• Brooke Turner Former name

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": "1540425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621468800000",
    "number": "1477020659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 NATCHEZ DR",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724049104",
            "telephone_number": "870-253-9293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1699 RED WOLF BLVD",
            "city": "JONESBORO",
            "state": "AR",
            "postal_code": "724015442",
            "telephone_number": "870-336-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BROOKE",
        "credential": "COTA/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-25",
        "last_updated": "2021-05-20",
        "certification_date": "2021-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "224Z00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapy Assistant",
            "state": "AR",
            "license": "OT-A1418",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "231884721",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BROOKE",
            "last_name": "TURNER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Walkwell PLLC
• Vanessa Wall, O.D.
• Aaron Jack Wallace, MD
• Anna Wallace
• Aubrey Wallace
• Feliece Wallace
• Gregory Wallace
• Jason David Wallace
• Latoya Wallace
• Pamela Wallace

• Occupational Therapy Assistant in Jonesboro, AR
• Providers in Jonesboro, AR by specialty
• Occupational Therapy Assistant in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 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.