Jonathan David Wallace, LOTR

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OTT.Z12243 Issued in LA

Practice address

870 Highway 516
Heflin, LA 71039-3726

Phone

(318) 614-5684

NPI assigned

Jul 25, 2022

Last updated

Jul 25, 2022By the provider in NPPES

Sex

Male

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

State licenses

Practice roles

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

• A to Z Therapy Solutions

  • Occupational Therapist
  • Heflin, LA
  • NPI 1659249589
  NPD Authorized official

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

{
    "created_epoch": "1658707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658707200000",
    "number": "1770219693",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "870 HIGHWAY 516",
            "city": "HEFLIN",
            "state": "LA",
            "postal_code": "710393726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "870 HIGHWAY 516",
            "city": "HEFLIN",
            "state": "LA",
            "postal_code": "710393726",
            "telephone_number": "318-614-5684"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JONATHAN",
        "middle_name": "DAVID",
        "credential": "LOTR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-07-25",
        "last_updated": "2022-07-25",
        "certification_date": "2022-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "LA",
            "license": "OTT.Z12243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• A to Z Therapy Solutions
• Humanity & Health Outreach, LLC
• Amy Katina Kyles, LOTR
• Sharolyn Montgomery
• Kimberly C Sumner, LOTR
• Kelly H Warren, APRN FNP-C

• Occupational Therapist in Heflin, LA
• Providers in Heflin, LA by specialty
• Occupational Therapist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2022; 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.