Provider Demographics
NPI:1467626895
Name:WALTERS, SHARON (OTR/L)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4921 BLUFFTON PKWY
Mailing Address - Street 2:APT. 136
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-4610
Mailing Address - Country:US
Mailing Address - Phone:856-522-9896
Mailing Address - Fax:
Practice Address - Street 1:4921 BLUFFTON PKWY
Practice Address - Street 2:APT. 136
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-4610
Practice Address - Country:US
Practice Address - Phone:856-522-9896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3036225X00000X
PAOC008931225X00000X
GAOT004747225X00000X
NJ46TR0212200225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist