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

Mr. Blake Wallace

Individual provider Occupational Therapy Assistant · NPI 1821617663

Mr. Blake Wallace is an Occupational Therapy Assistant in Germantown, Tennessee. Practices as a sole proprietor. Licensed in Mississippi.

Licensed in
MS
In the registry since
2020

Practice location Address checks out

7820 Walking Horse Cir
Germantown, TN 38138-2143
Phone: (901) 752-2500
Show map & directions

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

Specialties & licences

Occupational Therapy Assistant (primary) Taxonomy 224Z00000X · Licence TA3704 (MS)

Record details

NPI number1821617663
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedApril 12, 2020
Last updated in NPPESApril 12, 2020
Certification dateApril 12, 2020
Mailing address150 Evansville Rd, Coldwater, MS 38618-6778

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