Provider Demographics
NPI:1477787109
Name:WALTERS, ALINE ROSETTE (MS OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:ALINE
Middle Name:ROSETTE
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 1:861 E 242ND ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10470-1214
Mailing Address - Country:US
Mailing Address - Phone:347-613-0919
Mailing Address - Fax:718-994-3646
Practice Address - Street 1:861 E 242ND ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10470-1214
Practice Address - Country:US
Practice Address - Phone:347-613-0919
Practice Address - Fax:718-994-3646
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-09
Last Update Date:2009-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011261174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist