Savannah Lyn Wallace, OTR/L

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

2024001847 Issued in MO

Practice address

1818 W Worley St
Columbia, MO 65203-1038

Phone

(573) 214-3400

NPI assigned

Mar 12, 2024

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, IL2 enrollments

Enrollment records 2

Specialty

Occupational Therapist in Private Practice

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Athletico LTDGroup PAC ID 4789602681, shared by 41 NPIs, 2,187 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: savannah.wallace.p2@direct.athleticoltd.nextgenshare.com

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.

• Athletico LTD

  • Physical Therapist
  • Liberty, MO
  • NPI 1114449857

  Occupational Therapist

  Medicare reassignment NPD
• Athletico LTD

  • Physical Therapist
  • Oak Brook, IL
  • NPI 1821085028
  Medicare reassignment NPD
• Athletico LTD

  • Clinic/Center
  • Lafayette, IN
  • NPI 1053044867

  Occupational Therapist

  NPD
• Columbia Public Schools

  • Local Education Agency (LEA)
  • Columbia, MO
  • NPI 1639406051
  NPD (past)

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

{
    "created_epoch": "1710201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710201600000",
    "number": "1851159065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1294 COMMONS LOOP",
            "city": "FULTON",
            "state": "MO",
            "postal_code": "652511456",
            "telephone_number": "618-340-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 W WORLEY ST",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652031038",
            "telephone_number": "573-214-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "SAVANNAH",
        "middle_name": "LYN",
        "credential": "OTR/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-03-12",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "MO",
            "license": "2024001847",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Trellis Wallace, FNP-BC
• Erica Nichole Wallace
• McKenzie Wallace, MD
• Patricia Wallace
• Rebecca Wallace, LPC
• Erika McGraw Waller, PH.D.
• Marcia J Walmer, RN, AP/MHNP
• Hailey Walsh, MS, LPC
• Walter R. Pfitzinger D.D.S,, P.C.
• Amanda Gayle Walters, PHARMD

• Occupational Therapist in Columbia, MO
• Providers in Columbia, MO by specialty
• Occupational Therapist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2024; 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.