Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225X00000X | Occupational Therapist | 056003977 | IL |
NPI | 1003143546 |
---|---|
Provider Name | Kristen K Walsh |
First Address | East Moline, IL 61244-4044 |
Second Address | East Moline, IL 61244-4044 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/11/2009 |
Last Update Date | 04/11/2009 |