Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XH1200X | Occupational Therapist - Hand | 0234 | NC |
N | 225XH1200X | Occupational Therapist - Hand | OT006212 | GA |
NPI | 1114903564 |
---|---|
Provider Name | Mary M. Walsh |
First Address | Fayetteville, NC 28304-7089 |
Second Address | Fayetteville, NC 28304-3774 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 13/07/2020 |