Healthcare Provider Details

I. General information

NPI: 1851325161
Provider Name (Legal Business Name): LAUREN MARIE WALSH O.T., CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 CEDAR BLUFF DR
PETOSKEY MI
49770-8895
US

IV. Provider business mailing address

PO BOX 806
PETOSKEY MI
49770-0806
US

V. Phone/Fax

Practice location:
  • Phone: 231-347-5155
  • Fax:
Mailing address:
  • Phone: 231-348-4005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number5201001647
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: