Provider Demographics
NPI:1962118448
Name:WALSH, MELANIE JAYNE (OT)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:JAYNE
Last Name:WALSH
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:MRS M WALSH
Mailing Address - Street 2:523 OAKSHIRE PLACE
Mailing Address - City:ALAMO
Mailing Address - State:CA
Mailing Address - Zip Code:94507
Mailing Address - Country:US
Mailing Address - Phone:925-300-5563
Mailing Address - Fax:
Practice Address - Street 1:6001 NORRIS CANYON RD
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-5400
Practice Address - Country:US
Practice Address - Phone:915-577-8467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT16966225X00000X, 225XG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontologyGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist