Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jonathan David Wallace, LOTR

Individual provider Occupational Therapist · NPI 1770219693

Jonathan David Wallace, LOTR is an Occupational Therapist in Heflin, Louisiana. Practices as a sole proprietor. Licensed in Louisiana.

Licensed in
LA
In the registry since
2022

Practice location Address checks out

870 Highway 516
Heflin, LA 71039-3726
Phone: (318) 614-5684
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence OTT.Z12243 (LA)

Record details

NPI number1770219693
Entity typeIndividual (Type 1)
GenderMale
Credentials LOTR
Sole proprietorYes
NPI enumeratedJuly 25, 2022
Last updated in NPPESJuly 25, 2022
Certification dateJuly 25, 2022
Mailing address870 Highway 516, Heflin, LA 71039-3726

Other providers in Heflin