Provider Demographics
NPI:1053015081
Name:WALSH, SARAH ELIZABETH (COTA/L)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ELIZABETH
Last Name:WALSH
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4307 IRISBURG RD
Mailing Address - Street 2:
Mailing Address - City:AXTON
Mailing Address - State:VA
Mailing Address - Zip Code:24054-3465
Mailing Address - Country:US
Mailing Address - Phone:276-734-3512
Mailing Address - Fax:
Practice Address - Street 1:159 EXECUTIVE DR
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-231-2983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0131002805224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant