Provider Demographics
NPI:1578728861
Name:WELTY, TONYA MARIE (MS OTR/L)
Entity Type:Individual
Prefix:
First Name:TONYA
Middle Name:MARIE
Last Name:WELTY
Suffix:
Gender:F
Credentials:MS OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3625 SAINT JOSEPH RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9745
Mailing Address - Country:US
Mailing Address - Phone:812-948-0670
Mailing Address - Fax:812-948-0075
Practice Address - Street 1:3625 SAINT JOSEPH RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9745
Practice Address - Country:US
Practice Address - Phone:812-948-0670
Practice Address - Fax:812-948-0075
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-R3357225X00000X
IN31004122A225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist