Provider Demographics
NPI:1851558373
Name:WALSH, KAREN ELYSBETH (OTR)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:ELYSBETH
Last Name:WALSH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 OLD SAINT AUGUSTINE RD
Mailing Address - Street 2:STE 103
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-1081
Mailing Address - Country:US
Mailing Address - Phone:904-463-1565
Mailing Address - Fax:
Practice Address - Street 1:10800 OLD SAINT AUGUSTINE RD
Practice Address - Street 2:STE 103
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-1081
Practice Address - Country:US
Practice Address - Phone:904-463-1565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL OT 4808174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist