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

Individual provider Rehabilitation Psychologist · NPI 1639509862

Theresa Wallis is a Rehabilitation Psychologist in Shawnee, Oklahoma. Practices as a sole proprietor. Registered with an NPI since 2013.

In the registry since
2013
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Practice location Address checks out

201 N Broadway Ave
Shawnee, OK 74801-6917
Phone: (580) 748-0342
Fax: (405) 386-3213
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Rehabilitation Psychologist (primary) Taxonomy 103TR0400X

Record details

NPI number1639509862
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedNovember 25, 2013
Last updated in NPPESNovember 25, 2013