Individual
KIMBERLY JO WALTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OTR
Contact information
Practice address
8501 HARCOURT RD, INDIANAPOLIS, IN 46260-2046
(317) 875-9105
(317) 875-8638
Mailing address
8501 HARCOURT RD, INDIANAPOLIS, IN 46260-2046
(317) 875-9105
(317) 875-8638
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
31000516A
IN
225XH1200X
Hand Occupational Therapist
31000516A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000186321
ANTHEM HEALTH PLAN
—
05
—
200037030
—
IN
Enumeration date
09/15/2006
Last updated
03/27/2019
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