Provider Demographics
NPI:1649836529
Name:WALTON, ASHUNTI PRINCHE' (OTR/L)
Entity type:Individual
Prefix:
First Name:ASHUNTI
Middle Name:PRINCHE'
Last Name:WALTON
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 HIGHLANDS PKWY SE STE 150
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30082-5191
Mailing Address - Country:US
Mailing Address - Phone:770-433-2300
Mailing Address - Fax:
Practice Address - Street 1:3200 HIGHLANDS PKWY SE STE 150
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-5191
Practice Address - Country:US
Practice Address - Phone:770-433-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT007383225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist