1861619504 NPI number — MRS. ROSEMARY WALSH OTR

Table of content: MRS. ROSEMARY WALSH OTR (NPI 1861619504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861619504 NPI number — MRS. ROSEMARY WALSH OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861619504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5828 N SAINT LOUIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVELAND
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80538-1215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-797-0725
Provider Business Mailing Address Fax Number:
970-278-9396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
163 N CARTER LAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOVELAND
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80537-9751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-290-1759
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/20/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X , with the licence number:  1040552 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 84338563 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".