Wallace Wellness Therapy & Performance LLC

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

Legal business name

WALLACE WELLNESS THERAPY & PERFORMANCE LLC

Practice address

45752 Utica Park Blvd
Utica, MI 48315-5950

Phone

(330) 402-7541

NPI assigned

Jul 30, 2020

Last updated

Jul 30, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Lanee Arlett Wallace, MOT, OTR/LNPI 1508475047

Title

Occupational Therapist Otr/L

Phone

(330) 402-7541

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lanee Arlett Wallace, OTR/L

  • Occupational Therapist
  • Utica, MI
  • NPI 1508475047
  Authorized official Same address or phone

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

{
    "created_epoch": "1596067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1750990198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45752 UTICA PARK BLVD",
            "city": "UTICA",
            "state": "MI",
            "postal_code": "483155950",
            "telephone_number": "330-402-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45752 UTICA PARK BLVD",
            "city": "UTICA",
            "state": "MI",
            "postal_code": "483155950",
            "telephone_number": "330-402-7541"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALLACE WELLNESS THERAPY & PERFORMANCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-30",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "WALLACE",
        "authorized_official_first_name": "LANEE",
        "authorized_official_middle_name": "ARLETT",
        "authorized_official_title_or_position": "OCCUPATIONAL THERAPIST OTR/L",
        "authorized_official_telephone_number": "330-402-7541",
        "authorized_official_credential": "MOT, OTR/L"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clint Verran
• Lyubov Voyevidko, NP
• Vpa PC
• Dorothy Vukmirovich, M.S.
• Adrienne Walker
• Lanee Arlett Wallace, OTR/L
• Michael Washburn, M.M., M.A., CSAT-C
• Wentworth and Associates PC
• Wentworth and Associates, P.C.
• Lawrence T. Wentworth, PH.D.

• Occupational Therapist in Utica, MI
• Providers in Utica, MI by specialty
• Occupational Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; 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.