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General NPI Number Information
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NPI Number | 1245956168
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Entity Type | Individual
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Provider Name | KELSEY WALZ OTR
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Gender | Female
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Dates
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Enumeration Date | 10/12/2022
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Last Update Date | 10/12/2022
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Provider Practice Location Address
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Address Line | 13020 S CENTRAL AVE
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City | CRESTWOOD
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State | IL
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Zip | 60418-2710
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Country | US
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Telephone | 708-638-7135
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Fax |
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Provider Business Mailing Address
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Address Line | 4034 N GRANT ST
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City | WESTMONT
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State | IL
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Zip | 60559-1314
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Country | US
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Telephone |
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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 |
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License Number State |
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