Provider Demographics
NPI:1417938440
Name:WALSH, WILLIAM WARD (OTR/L, CHT)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WARD
Last Name:WALSH
Suffix:
Gender:M
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8823 PRODUCTION LN
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6511
Mailing Address - Country:US
Mailing Address - Phone:423-238-7217
Mailing Address - Fax:423-954-7408
Practice Address - Street 1:610 N FAYETTEVILLE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-4670
Practice Address - Country:US
Practice Address - Phone:336-633-4263
Practice Address - Fax:336-633-4267
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0456225X00000X
NC9105001166225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7301039Medicaid
NC66987OtherMEDCOST
NC670000777OtherMEDICARE RAILROAD
NC85547OtherBLUE CROSS/BLUE SHIELD
NC66987OtherMEDCOST