Provider Demographics
NPI:1558848804
Name:WALLING, PAYTON SCOTT
Entity Type:Individual
Prefix:
First Name:PAYTON
Middle Name:SCOTT
Last Name:WALLING
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRADLY
Other - Middle Name:PAYTON SCOTT
Other - Last Name:WALLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:407 E 2ND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1428
Mailing Address - Country:US
Mailing Address - Phone:509-455-6002
Mailing Address - Fax:
Practice Address - Street 1:407 E 2ND AVE STE 100
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1428
Practice Address - Country:US
Practice Address - Phone:509-455-6002
Practice Address - Fax:509-747-5990
Is Sole Proprietor?:No
Enumeration Date:2018-07-19
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WAOT61316314225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician