Waller, Eulanda Lara
Waller, Eulanda Lara is an sole proprietor health care provider with primary practice located at 315 Christina Ct , Macon GA 31217-4528. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, which is considered as her primary health care specialty. Waller, Eulanda Lara can be contacted via phone (478) 318-2313.Contact Information
Primary practice address
315 Christina Ct
Macon GA 31217-4528
Phone: (478) 318-2313
Fax: (478) 755-0335
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist | 225X00000X | OT003394 | Georgia |
Profile Details
| NPI number | 1073759619 |
|---|---|
| LBN Legal business name | Waller, Eulanda Lara |
| Credentials | OTR/L |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jan 4th, 2009 |
| Last updated | Feb 28th, 2013 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1073759619 | NPPES |
| Georgia | MEDICAID | 874780070A |
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