Provider Demographics
NPI:1861645517
Name:WALSH, MARY PATRICIA (OTR/L, LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PATRICIA
Last Name:WALSH
Suffix:
Gender:F
Credentials:OTR/L, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:848 PALMER RD
Mailing Address - Street 2:APT. 3C
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3322
Mailing Address - Country:US
Mailing Address - Phone:914-548-7286
Mailing Address - Fax:
Practice Address - Street 1:848 PALMER RD
Practice Address - Street 2:APT. 3C
Practice Address - City:BRONXVILLE
Practice Address - State:NY
Practice Address - Zip Code:10708-3322
Practice Address - Country:US
Practice Address - Phone:914-548-7286
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014820-1225700000X
NY009411-1225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist