Theresa Wallis

Primary specialty

Rehabilitation PsychologistTaxonomy code 103TR0400X

Practice address

201 N Broadway Ave
Shawnee, OK 74801-6917

Phone

(580) 748-0342

Fax

(405) 386-3213

NPI assigned

Nov 25, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1385337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385337600000",
    "number": "1639509862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 EASTWAY",
            "city": "MCLOUD",
            "state": "OK",
            "postal_code": "748518566",
            "telephone_number": "580-748-0342",
            "fax_number": "405-386-3213"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 N BROADWAY AVE",
            "city": "SHAWNEE",
            "state": "OK",
            "postal_code": "748016917",
            "telephone_number": "580-748-0342",
            "fax_number": "405-386-3213"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLIS",
        "first_name": "THERESA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-25",
        "last_updated": "2013-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Walker
• Tessa Walker, PTA
• Alyssa Wall
• Lydia Wall
• Angela D Wallace
• Teola M Walls
• Christine Chouteau Walsh, M.D.
• Monica Wandro, DDS
• Lisa Renee Warrington, APRN
• Dominque Latreace Wathan, CMII, BHWC

• Rehabilitation Psychologist in Shawnee, OK
• Providers in Shawnee, OK by specialty
• Rehabilitation Psychologist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2013; 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.