Provider Demographics
NPI:1295537926
Name:WALTERS, NOEL ANASTASIA
Entity type:Individual
Prefix:
First Name:NOEL
Middle Name:ANASTASIA
Last Name:WALTERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BIG BEND RD APT 221
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7650
Mailing Address - Country:US
Mailing Address - Phone:314-750-6707
Mailing Address - Fax:
Practice Address - Street 1:4 ARNOLD MALL
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MO
Practice Address - Zip Code:63010-2223
Practice Address - Country:US
Practice Address - Phone:636-282-0056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2025007824225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist