Eli William Wallace, OT

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

OTT.200733 Issued in LA

Practice address

400 Polly LN
Lafayette, LA 70508-4966

Phone

(337) 443-0652

NPI assigned

Jun 17, 2024

Last updated

Jun 17, 2024By the provider in NPPES

Sex

Male

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 LA

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Louisiana Physical Therapy Services of Lafayette, LLCGroup PAC ID 4183012461, 3 clinicians

Acadian Physical Therapy Services LLCGroup PAC ID 8123311875, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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.

• Acadian Physical Therapy Services, LLC

  • Physical Therapist
  • Lafayette, LA
  • NPI 1043676554

  Occupational Therapist

  Medicare reassignment Care Compare group NPD
• Louisiana Physical Therapy Services of Lafayette LLC

  dba Louisiana Physical Therapy Services of Lafayette

  • Physical Therapist
  • Lafayette, LA
  • NPI 1316614217

  Occupational Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1718582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718582400000",
    "number": "1891538070",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 CONCERTO CRST",
            "city": "DUSON",
            "state": "LA",
            "postal_code": "705293352",
            "telephone_number": "337-258-5264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 POLLY LN",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705084966",
            "telephone_number": "337-443-0652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "ELI",
        "middle_name": "WILLIAM",
        "credential": "OT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-06-17",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "LA",
            "license": "OTT.200733",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Luther Walker, PT
• Shaun Walker, DO
• Amanda Wallace, DPT
• Dana Wallace, PHD, LPC-S, NCC
• Dionne Wallace
• Maria Hebert Wallace, LCSW
• Sarah L Wallace, NP
• Lane Jhase Waller
• Billie Sue Wallis, LCSW
• Judy Werger Wallis, MSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 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.