Individual provider · Type 1 NPI
Tara Wallace, LMT, MMP
Specialist · O Fallon, MO
NPI number
1790124378
Active
Practice location
2633 Babble Creek Ln
O Fallon, MO 63368-8338
Fax (636) 294-0837
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Specialist Primary | 174400000X | 2001032642 (MO) |
Specialist: An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
Other specialist providers in O Fallon
About NPI 1790124378
Tara Wallace, LMT, MMP's National Provider Identifier is 1790124378, issued on Jun 18, 2013. The primary taxonomy on file is Specialist (174400000X), and the practice location is in O Fallon, MO. The record was last updated on Jun 18, 2013.