Provider Demographics
NPI:1497975080
Name:WALTERS, KATHIE MARIE (OTR)
Entity Type:Individual
Prefix:MRS
First Name:KATHIE
Middle Name:MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2816 BECERRA WAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95821-5421
Mailing Address - Country:US
Mailing Address - Phone:916-487-3276
Mailing Address - Fax:
Practice Address - Street 1:366 ELM AVE
Practice Address - Street 2:SUITE 252
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95603-4525
Practice Address - Country:US
Practice Address - Phone:916-367-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT 2885225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist