Provider Demographics
NPI:1346720323
Name:WALCHLI, WANJA WACIUMA (COTA)
Entity Type:Individual
Prefix:MS
First Name:WANJA
Middle Name:WACIUMA
Last Name:WALCHLI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 JOHN WEST RD APT 11102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75228-8841
Mailing Address - Country:US
Mailing Address - Phone:469-877-4282
Mailing Address - Fax:
Practice Address - Street 1:2815 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75215-2320
Practice Address - Country:US
Practice Address - Phone:214-586-1095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-18
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211126224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant