Maxine Walsh

Primary specialty

Occupational TherapistTaxonomy code 225X00000X

License

001136 Issued in CT

Practice address

4200 Park Ave
Bridgeport, CT 06604-1049

Phone

(203) 365-6443

Fax

(203) 396-1046

NPI assigned

Mar 15, 2010

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Miss Maxine Moura Former name

Medicare fee-for-service enrollment

Enrolled in CT

Enrollment records 1

Specialty

Occupational Therapist in Private Practice

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jewish Home for the Elderly of Fairfield County IncorporatedGroup PAC ID 6901706332, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jewish Home for the Elderly of Fairfield County Incorporated

  • Rehabilitation Clinic/Center
  • Bridgeport, CT
  • NPI 1285962928
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750896000000",
    "number": "1194049577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041049",
            "telephone_number": "203-365-6443",
            "fax_number": "203-396-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4200 PARK AVE",
            "city": "BRIDGEPORT",
            "state": "CT",
            "postal_code": "066041049",
            "telephone_number": "203-365-6443",
            "fax_number": "203-396-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "MAXINE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-03-15",
        "last_updated": "2025-06-26",
        "certification_date": "2025-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "CT",
            "license": "001136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MAXINE",
            "last_name": "MOURA",
            "prefix": "MISS",
            "credential": "OT",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Kereen Semone Waller Simpson
• Nancy Wallick, CRNA
• Carol Ann Walsh, RN
• Carolyn Walsh, CPNP
• Deanne Walsh, APRN
• Lansheng Wang, MD
• Ximi Kevin Wang, MD
• Conor James Ward, APRN
• Douglas J. Ward, PA-C
• Madgelee K Ward

• Occupational Therapist in Bridgeport, CT
• Providers in Bridgeport, CT by specialty
• Occupational Therapist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.