Provider Demographics
NPI:1083030183
Name:WALCH, ASHLEY (OTR/L, MOT)
Entity Type:Individual
Prefix:
First Name:ASHLEY
Middle Name:
Last Name:WALCH
Suffix:
Gender:F
Credentials:OTR/L, MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 MALTA RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-9703
Mailing Address - Country:US
Mailing Address - Phone:407-832-3829
Mailing Address - Fax:
Practice Address - Street 1:211 MALTA RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-9703
Practice Address - Country:US
Practice Address - Phone:407-832-3829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-13
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 16218171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor