Mary Wallace, OTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2022037104 Issued in MO

Practice address

2150 W Randolph St
Saint Charles, MO 63301-0844

Phone

(636) 946-4966

NPI assigned

Sep 28, 2022

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

Enrolled in MO

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fox Rehabilitation Services OT Mo LLCGroup PAC ID 4587089925, 18 clinicians

Legacy Healthcare Services IncGroup PAC ID 2163339722, 3,431 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fox Rehabilitation Services OT Mo LLC

  • Occupational Therapist
  • Saint Charles, MO
  • NPI 1386269363
  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services Inc.

  • Physical Therapist
  • Washington, MO
  • NPI 1407487366

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Legacy Healthcare Services Inc

  • Physical Therapist
  • Cary, NC
  • NPI 1225879489

  Occupational Therapist

  NPD

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681430400000",
    "number": "1689398141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7527 TEASDALE AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631303923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2150 W RANDOLPH ST",
            "city": "SAINT CHARLES",
            "state": "MO",
            "postal_code": "633010844",
            "telephone_number": "636-946-4966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "MARY",
        "credential": "OTR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-28",
        "last_updated": "2023-04-14",
        "certification_date": "2023-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2022037104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tricia Walker
• William V Walker, MD
• John M Walkonis, DDS
• Aimee Rose Wallace, MA, LPC
• David Stuart Wallace, D.C.
• Joseph G Waller, M.D., M.P.H.
• James Walsh
• Martin J Walsh, M.D.
• Alexandria Michelle Walter, M.S., CCC-SLP
• Matthew Alexander Walter, D.C.

• Occupational Therapist in Saint Charles, MO
• Providers in Saint Charles, MO by specialty
• Occupational Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.