Provider Demographics
NPI:1245502830
Name:WALLS, BARBARA ANN (OTR)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ANN
Last Name:WALLS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:ROCHELLE
Mailing Address - State:GA
Mailing Address - Zip Code:31079-8637
Mailing Address - Country:US
Mailing Address - Phone:229-567-5343
Mailing Address - Fax:
Practice Address - Street 1:539 BIRCH RD
Practice Address - Street 2:
Practice Address - City:ROCHELLE
Practice Address - State:GA
Practice Address - Zip Code:31079-8637
Practice Address - Country:US
Practice Address - Phone:229-567-5343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT004958225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist