Provider Demographics
NPI:1295573707
Name:WALTON, JOLEE MICHELLE (MOTR/L)
Entity type:Individual
Prefix:
First Name:JOLEE
Middle Name:MICHELLE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 GORRELLS RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBOURNE
Mailing Address - State:WV
Mailing Address - Zip Code:26149-7585
Mailing Address - Country:US
Mailing Address - Phone:304-771-7744
Mailing Address - Fax:
Practice Address - Street 1:42 GORRELLS RUN RD
Practice Address - Street 2:
Practice Address - City:MIDDLEBOURNE
Practice Address - State:WV
Practice Address - Zip Code:26149-7585
Practice Address - Country:US
Practice Address - Phone:304-771-7744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-18
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2379225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist