Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XG0600X | Occupational Therapist - Gerontology | OT005713 | OH |
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC002055L | PA |
NPI | 1710216551 |
---|---|
Provider Name | Ms. Monica Aurelia Walls |
First Address | Hermitage, PA 16148-1679 |
Second Address | New Wilmington, PA 16142-1446 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2009 |
Last Update Date | 07/12/2009 |