Provider Demographics
NPI:1396988630
Name:WALTERS, OTEKA AUSTIN (MS, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:OTEKA
Middle Name:AUSTIN
Last Name:WALTERS
Suffix:
Gender:F
Credentials:MS, CCC/SLP
Other - Prefix:
Other - First Name:TEKE
Other - Middle Name:AUSTIN
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS,CCC/SLP
Mailing Address - Street 1:6309 JUNEAU RD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1613
Mailing Address - Country:US
Mailing Address - Phone:817-731-8480
Mailing Address - Fax:
Practice Address - Street 1:6309 JUNEAU RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1613
Practice Address - Country:US
Practice Address - Phone:817-731-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-16
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16389235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist