1346923687 NPI number — DR. KATHRYN PHELAN WALSH OTD, OTR/L

Table of content: DR. KATHRYN PHELAN WALSH OTD, OTR/L (NPI 1346923687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346923687 NPI number — DR. KATHRYN PHELAN WALSH OTD, OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
KATHRYN
Provider Middle Name:
PHELAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OTD, OTR/L
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:
1346923687
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 PRESTWICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCHERERVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46375-2939
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-218-5988
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6685 E 117TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-7808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-662-0642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/11/2023

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:  31008133A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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