Provider Demographics
NPI:1356150288
Name:WOLTER, KATHERINE (MT-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:WOLTER
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5534 DONATELLO DR 92
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-9220
Mailing Address - Country:US
Mailing Address - Phone:260-442-6545
Mailing Address - Fax:
Practice Address - Street 1:1400 AIRPORT NORTH OFFICE PARK STE D
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-6723
Practice Address - Country:US
Practice Address - Phone:260-702-9141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN19078225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist