Healthcare Provider Details

I. General information

NPI: 1164441606
Provider Name (Legal Business Name): KERRY MARIE WALSH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12110 WALDEN WOODS DR
ORLANDO FL
32826-2231
US

IV. Provider business mailing address

12110 WALDEN WOODS DR
ORLANDO FL
32826-2231
US

V. Phone/Fax

Practice location:
  • Phone: 407-579-1719
  • Fax:
Mailing address:
  • Phone: 407-579-1719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberOT11296
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: