Provider Demographics
NPI:1306383542
Name:WELSH, TORI
Entity Type:Individual
Prefix:
First Name:TORI
Middle Name:
Last Name:WELSH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E WAYLAND ST
Mailing Address - Street 2:
Mailing Address - City:GOODLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47948-8171
Mailing Address - Country:US
Mailing Address - Phone:219-816-0791
Mailing Address - Fax:
Practice Address - Street 1:110 E WAYLAND ST
Practice Address - Street 2:
Practice Address - City:GOODLAND
Practice Address - State:IN
Practice Address - Zip Code:47948-8171
Practice Address - Country:US
Practice Address - Phone:219-816-0791
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer