Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
TARA WALLACE, LMT, MMP
Active Sole ProprietorSpecialist · O FALLON, MO
Registration Details
- NPI Number
- 1790124378
- Provider Type
- Individual
- Gender
- Female
- NPI Issued
- Jun 18, 2013 (12.872227614909 yrs)
- Last Updated
- Jun 18, 2013
- License
-
2001032642 (MO)
- Sole Proprietor
- Yes
Practice Information
- Address
-
2633 BABBLE CREEK LNO FALLON, MO, 633688338Browse MO providers · Browse ZIP 63368
- Phone
- 6365771216
- Fax
- 6362940837
- Primary Specialty
-
Specialist
174400000X
Other Specialist Providers in O FALLON, MO
| Name | Credential | NPI |
|---|---|---|
| MR. MICHAEL PHILLIP BRUECKMANN | LMT, NCTMB | 1104939552 |
| HEIDI BLAYLOCK | BCBA | 1851574537 |
| REBECCA A BETHEL | P.T. | 1871822536 |
| JANICE MARIE SMITH | MA, BCBA | 1649576646 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.