Provider Demographics
NPI:1043503147
Name:WALTERS, KATIE BROOKE (MOT,OTR/L)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:BROOKE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MOT,OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 WOODBURY PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16659-9506
Mailing Address - Country:US
Mailing Address - Phone:814-766-2295
Mailing Address - Fax:814-766-2642
Practice Address - Street 1:2230 WOODBURY PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:LOYSBURG
Practice Address - State:PA
Practice Address - Zip Code:16659-9506
Practice Address - Country:US
Practice Address - Phone:814-766-2295
Practice Address - Fax:814-766-2642
Is Sole Proprietor?:No
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC011505225XP0019X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0019XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPhysical Rehabilitation