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Individual

MRS. JENNIFER LEIGH WALTON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OTR/L

Contact information

Practice address
2711 RANDOLPH RD, SUITE 509, CHARLOTTE, NC 28207-2034
(704) 575-1633
Mailing address
8416 QUARTERS LN, CHARLOTTE, NC 28227-9788
(704) 575-1633

Taxonomy

Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
5708
NC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
7301856
NC
Enumeration date
08/26/2006
Last updated
07/08/2007
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