Provider Demographics
NPI:1740578228
Name:WALTERS, TANYA LYNN (OTR/L)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:LYNN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 CORAOPOLIS RD
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4006
Mailing Address - Country:US
Mailing Address - Phone:412-299-7961
Mailing Address - Fax:
Practice Address - Street 1:354 CORAOPOLIS RD
Practice Address - Street 2:
Practice Address - City:CORAOPOLIS
Practice Address - State:PA
Practice Address - Zip Code:15108-4006
Practice Address - Country:US
Practice Address - Phone:412-299-7961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC004143L225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist