Provider Demographics
NPI:1942687538
Name:WALTER, CHRISTINE MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:MARIE
Last Name:WALTER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14511 WESTLAKE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-7783
Mailing Address - Country:US
Mailing Address - Phone:503-598-8099
Mailing Address - Fax:503-598-3980
Practice Address - Street 1:14511 WESTLAKE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-7783
Practice Address - Country:US
Practice Address - Phone:503-598-8099
Practice Address - Fax:503-598-3980
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-03
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6186247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other