Provider Demographics
NPI:1528392180
Name:WALTERS, WENDY MARIE (OT)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:MARIE
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 GIRARD AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-1331
Mailing Address - Country:US
Mailing Address - Phone:443-326-8134
Mailing Address - Fax:
Practice Address - Street 1:2012 GIRARD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1331
Practice Address - Country:US
Practice Address - Phone:443-326-8134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04617225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist