Individual
MR. MARC BRYAN WALTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2418 ERIE DR, CONCORD, CA 94519-2155
(215) 888-4452
Mailing address
1485 INTERNATIONAL PKWY, HEATHROW, FL 32746-5303
(800) 798-6035
(888) 798-6035
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
OP003008L
PA
224Z00000X
Occupational Therapy Assistant
Primary
OT2513
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OP003008L
STATE LICENSE
PA
01
—
OTA2513
STATE LICENSE
CA
Enumeration date
10/29/2007
Last updated
01/22/2020
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