Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | OT17653 | FL |
NPI | 1003276619 |
---|---|
Provider Name | Kaitlin Walsh |
First Address | Clermont, FL 34712-0547 |
Second Address | Clermont, FL 34711-6816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2016 |
Last Update Date | 04/03/2016 |