Provider Demographics
NPI:1316378649
Name:WALTON, KATINA
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:
Last Name:WALTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1822
Mailing Address - Street 2:
Mailing Address - City:NORMAL
Mailing Address - State:AL
Mailing Address - Zip Code:35762-1822
Mailing Address - Country:US
Mailing Address - Phone:256-975-7102
Mailing Address - Fax:
Practice Address - Street 1:500 FAIRWAY DR
Practice Address - Street 2:102
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33441-1814
Practice Address - Country:US
Practice Address - Phone:256-975-7102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist