Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0019X | Occupational Therapist - Physical Rehabilitation | OC011505 | PA |
NPI | 1043503147 |
---|---|
Provider Name | Katie Brooke Walters |
First Address | Loysburg, PA 16659-9506 |
Second Address | Loysburg, PA 16659-9506 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2011 |
Last Update Date | 23/05/2011 |