Provider Demographics
NPI:1477288546
Name:WALSH, JONI MICHELLE (COTA/L)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:MICHELLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4535 JOCELYN RD W
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-1335
Mailing Address - Country:US
Mailing Address - Phone:407-497-1120
Mailing Address - Fax:
Practice Address - Street 1:4535 JOCELYN RD W
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-1335
Practice Address - Country:US
Practice Address - Phone:407-497-1120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA13172224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant