Provider Demographics
NPI:1689694812
Name:WALTER, JEAN-MARIE A (CTRS)
Entity Type:Individual
Prefix:
First Name:JEAN-MARIE
Middle Name:A
Last Name:WALTER
Suffix:
Gender:F
Credentials:CTRS
Other - Prefix:
Other - First Name:JEAN-MARIE
Other - Middle Name:A
Other - Last Name:SHEEHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CTRS
Mailing Address - Street 1:2907 PLEASANT VALLEY BLVD
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-4305
Mailing Address - Country:US
Mailing Address - Phone:814-943-8164
Mailing Address - Fax:814-940-7890
Practice Address - Street 1:2907 PLEASANT VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-943-8164
Practice Address - Fax:814-940-7890
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225800000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRecreation Therapist