Provider Demographics
NPI:1437276516
Name:WALSH, MARY DANIELLE (COTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DANIELLE
Last Name:WALSH
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 JAMES HAYWARD RD
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1239
Mailing Address - Country:US
Mailing Address - Phone:610-361-8348
Mailing Address - Fax:
Practice Address - Street 1:1194 NAAMANS CREEK RD
Practice Address - Street 2:
Practice Address - City:BOOTHWYN
Practice Address - State:PA
Practice Address - Zip Code:19061-1615
Practice Address - Country:US
Practice Address - Phone:610-558-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOP002175L224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant