Tara Wallace, LMT, MMP Valid NPI
Individual provider · Specialist · O Fallon, MO
- NPI
- 1790124378
- Type
- Individual (Type 1)
- Primary specialty
- Specialist
- Specialty group
- Other Service Providers
- Taxonomy code
- 174400000X
- License number
- 2001032642 (MO)
- Sex
- Female
- Sole proprietor
- Yes
- Enumerated
- 2013-06-18
- Last updated
- 2013-06-18
Practice location
2633 Babble Creek Ln
O Fallon, MO 63368-8338
(636) 577-1216