Provider Demographics
NPI:1972797157
Name:WALSH, JENNIFER M (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:M
Last Name:WALSH
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 EASTBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8496
Mailing Address - Country:US
Mailing Address - Phone:407-956-0232
Mailing Address - Fax:
Practice Address - Street 1:477 EASTBRIDGE DR
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-8496
Practice Address - Country:US
Practice Address - Phone:407-956-0232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 11504225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics