Active NPI
Fallon Wallace, COTA
- Occupational Therapy Assistant
- Hayward, CA
National Provider Identifier
1659912756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapy Assistant
- License
- OTA4830
- Practice address
- 22822 Myrtle St
Hayward, CA 94541-6321 - Phone
- (510) 537-4844
- NPI assigned
- Oct 1, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Occupational Therapy Assistant | 224Z00000X | OTA4830 | CA | Primary |
Addresses
Primary practice location
22822 Myrtle St
Hayward, CA 94541-6321
Mailing address
342 Lynda LN
Lexington, NC 27295-7948
Phone (336) 239-1465
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OTA4830 | CA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1569888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1569888000000",
"number": "1659912756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "342 LYNDA LN",
"city": "LEXINGTON",
"state": "NC",
"postal_code": "272957948",
"telephone_number": "336-239-1465"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22822 MYRTLE ST",
"city": "HAYWARD",
"state": "CA",
"postal_code": "945416321",
"telephone_number": "510-537-4844"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "FALLON",
"credential": "COTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-01",
"last_updated": "2019-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "224Z00000X",
"taxonomy_group": "",
"desc": "Occupational Therapy Assistant",
"state": "CA",
"license": "OTA4830",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hayward, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.