Provider Demographics
NPI:1790942563
Name:WALTERS, ANDREW OXLEY (OT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:OXLEY
Last Name:WALTERS
Suffix:
Gender:M
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E BIDWELL ST
Mailing Address - Street 2:201
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-3452
Mailing Address - Country:US
Mailing Address - Phone:916-983-5915
Mailing Address - Fax:916-983-5925
Practice Address - Street 1:1301 E BIDWELL ST
Practice Address - Street 2:201
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3452
Practice Address - Country:US
Practice Address - Phone:916-983-5915
Practice Address - Fax:916-983-5925
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2884225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist