Provider Demographics
NPI:1528380094
Name:WALLIN, KARIN MARIE (COTA)
Entity Type:Individual
Prefix:MRS
First Name:KARIN
Middle Name:MARIE
Last Name:WALLIN
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 COLLEGE CIR
Mailing Address - Street 2:SUNY GENESEO - HOLCOMB BUILDING
Mailing Address - City:GENESEO
Mailing Address - State:NY
Mailing Address - Zip Code:14454-1401
Mailing Address - Country:US
Mailing Address - Phone:585-245-5688
Mailing Address - Fax:585-245-5685
Practice Address - Street 1:1 COLLEGE CIR
Practice Address - Street 2:SUNY GENESEO - HOLCOMB BUILDING
Practice Address - City:GENESEO
Practice Address - State:NY
Practice Address - Zip Code:14454-1401
Practice Address - Country:US
Practice Address - Phone:585-245-5688
Practice Address - Fax:585-245-5685
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY007363-1224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant