Individual
MARY L WALTERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.D., R.D.
Contact information
Practice address
7082 QUAIL LAKES DR, HOLLAND, OH 43528-9389
(419) 349-8000
Mailing address
7082 QUAIL LAKES DR, HOLLAND, OH 43528-9389
(419) 349-8000
(419) 536-5038
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
OH 126
OH
172A00000X
Driver
—
—
3747P1801X
Personal Care Attendant
—
—
376J00000X
Homemaker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0192244
—
OH
01
—
4809121
OHIO DEPT. OF DEVELOPMENTAL DISABILITIES
OH
Enumeration date
10/09/2007
Last updated
11/17/2020
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