Provider Demographics
NPI:1407346711
Name:WALTERS, PAMELA JEAN (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:849 JEFFCO BLVD
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-1409
Mailing Address - Country:US
Mailing Address - Phone:636-282-5184
Mailing Address - Fax:636-282-6982
Practice Address - Street 1:849 JEFFCO BLVD
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-1409
Practice Address - Country:US
Practice Address - Phone:636-282-5184
Practice Address - Fax:636-282-6982
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000613225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist