MEDICARE: JORDAN ASHLEY WALSH OTD, OTR/L

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	OTP-OT-LIC-10534	MT

General Provider Information

NPI Number	:	1376320218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN ASHLEY WALSH OTD, OTR/L

Provider Business Mailing Address
First Line	:	2747 ENTERPRISE AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-7412
Country	:	US
Telephone Number	:	406-534-2087
Fax Number	:	406-534-2153

Provider Business Practice Location Address
First Line	:	2747 ENTERPRISE AVE
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-7412
Country	:	US
Telephone Number	:	406-534-2087
Fax Number	:	406-534-2153

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

Provider Enumeration Date	:	09/13/2023
Last Update Date	:	09/13/2023

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