Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XP0200X | Occupational Therapist - Pediatrics | 1552 | CO |
NPI | 1063749950 |
---|---|
Provider Name | Mrs. Marlene Leslie Waltz |
First Address | Evergreen, CO 80439-8970 |
Second Address | Evergreen, CO 80439-8970 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/11/2009 |
Last Update Date | 12/11/2009 |