Provider Demographics
NPI:1659768539
Name:WALTER, JESSICA MARIE (PHD, ATC)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:MARIE
Last Name:WALTER
Suffix:
Gender:F
Credentials:PHD, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28871 LQ POWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:MD
Mailing Address - Zip Code:21838-2551
Mailing Address - Country:US
Mailing Address - Phone:443-880-8579
Mailing Address - Fax:
Practice Address - Street 1:1101 CAMDEN AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-6837
Practice Address - Country:US
Practice Address - Phone:410-543-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-19
Last Update Date:2015-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer