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NPI Code Detail

MEDICARE: THERESA M WALSH OTR/L

MEDICARE: THERESA M WALSH 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
1225XP0200XPediatric Occupational TherapistOT13782FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1OT13782OTHERFLFLORIDA DEPARTMENT OF HEALTH

General Provider Information

NPI Number : 1740502723
Entity Type Code : Individual
Provider Name (Legal Business Name) : THERESA M WALSH OTR/L
Provider Business Mailing Address
First Line : 5013 CORSICA SQ
Second Line :
City : VERO BEACH
State : FL
Zip : 32967-7683
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2959 W MIDWAY RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34981-4956
Country : US
Telephone Number : 772-462-6601
Fax Number : 772-462-6634
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2010
Last Update Date : 02/18/2010

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Directions to “ THERESA M WALSH OTR/L” Practice Location

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