Provider Demographics
NPI:1376320218
Name:WALSH, JORDAN ASHLEY (OTD, OTR/L)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:ASHLEY
Last Name:WALSH
Suffix:
Gender:F
Credentials:OTD, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2747 ENTERPRISE AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-7412
Mailing Address - Country:US
Mailing Address - Phone:406-534-2087
Mailing Address - Fax:406-534-2153
Practice Address - Street 1:2747 ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-7412
Practice Address - Country:US
Practice Address - Phone:406-534-2087
Practice Address - Fax:406-534-2153
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTOTP-OT-LIC-10534225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist