Provider Demographics
NPI:1770777187
Name:WALTER, HEATHER (ATC)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:WALTER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 CENTRAL PKWY
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45214-2863
Mailing Address - Country:US
Mailing Address - Phone:513-381-4901
Mailing Address - Fax:513-381-4903
Practice Address - Street 1:1555 CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45214-2863
Practice Address - Country:US
Practice Address - Phone:513-381-4901
Practice Address - Fax:513-381-4903
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ3-00003072255A2300X
OHAT.0029842255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
0225920002Medicare NSC