MEDICARE: ANNA H. WALLS OCCUPATIONAL THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	4739	NC

General Provider Information

NPI Number	:	1053317321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNA H. WALLS OCCUPATIONAL THERAPY

Provider Business Mailing Address
First Line	:	45 PLATEAU ST
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-4200
Country	:	US
Telephone Number	:	828-488-4009
Fax Number	:	828-586-7235

Provider Business Practice Location Address
First Line	:	45 PLATEAU ST
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-4200
Country	:	US
Telephone Number	:	828-488-4009
Fax Number	:	828-586-7235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	12/13/2012

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