Provider Demographics
NPI:1205574654
Name:WALSH, MOLLIE TERESE (OTR)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:TERESE
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 1:12 BAILEY AVE
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-2009
Mailing Address - Country:US
Mailing Address - Phone:631-697-2028
Mailing Address - Fax:
Practice Address - Street 1:12 BAILEY AVE
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-2009
Practice Address - Country:US
Practice Address - Phone:631-697-2028
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026875225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist