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

Mary Wallace, OTR

Individual provider Occupational Therapist · NPI 1689398141

Mary Wallace, OTR is an Occupational Therapist in Private Practice in Saint Charles, Missouri. Qualified in 2022, 4 years ago. Practices with Fox Rehabilitation Services OT Mo LLC, an 18-clinician group and accepts Medicare assignment. Licensed in Missouri.

Years since qualifying
4
Licensed in
MO
In the registry since
2022
What do these letters mean?
OTR — Occupational Therapist, Registered
A nationally registered occupational therapist.

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Practice location Address checks out

2150 W Randolph St
Saint Charles, MO 63301-0844
Phone: (636) 946-4966
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Occupational Therapist (primary) Taxonomy 225X00000X · Licence 2022037104 (MO)

Record details

NPI number1689398141
Entity typeIndividual (Type 1)
GenderFemale
Credentials OTR
Sole proprietorNo
NPI enumeratedSeptember 28, 2022
Last updated in NPPESApril 14, 2023
Certification dateApril 14, 2023
Mailing address7527 Teasdale Ave, Saint Louis, MO 63130-3923

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyOCCUPATIONAL THERAPIST IN PRIVATE PRACTICE
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Fox Rehabilitation Services Ot Mo Llc — 18 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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