Provider Demographics
NPI:1245787050
Name:WALSH, ELANORE (RBT)
Entity Type:Individual
Prefix:
First Name:ELANORE
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ELANORE
Other - Middle Name:
Other - Last Name:HUME
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3974 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79603-4113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3974 WILSHIRE DR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79603-4113
Practice Address - Country:US
Practice Address - Phone:325-701-0596
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist