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General NPI Number Information
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NPI Number | 1245449651
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Entity Type | Individual
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Provider Name | WALTER R. VANDYCK OTR
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Gender | Male
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | SPRINGFIELD MIDDLE SCHOOL, PROVIDENE SCHOOL DEPARTMENT 152 SPRINGFIELD ST
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City | PROVIDENCE
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State | RI
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Zip | 02909
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Country | US
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Telephone | 401-278-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 10 CANONCHET ST
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City | PROVIDENCE
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State | RI
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Zip | 02908-3802
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Country | US
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Telephone | 401-751-0109
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number | 80
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License Number State | RI
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