Provider Demographics
NPI:1942607221
Name:WALSH, STACEY (OTR/L, M ED)
Entity Type:Individual
Prefix:MS
First Name:STACEY
Middle Name:
Last Name:WALSH
Suffix:
Gender:F
Credentials:OTR/L, M ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5572 PRINCETON RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45011
Mailing Address - Country:US
Mailing Address - Phone:513-644-1197
Mailing Address - Fax:
Practice Address - Street 1:5572 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45011-9726
Practice Address - Country:US
Practice Address - Phone:513-644-1197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-02
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH04500225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist