Provider Demographics
NPI:1003642372
Name:WALTON, MARY KATHERINE (MSOT R/L)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHERINE
Last Name:WALTON
Suffix:
Gender:F
Credentials:MSOT R/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1220 KY HIGHWAY 801 S
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-8720
Mailing Address - Country:US
Mailing Address - Phone:606-548-0590
Mailing Address - Fax:
Practice Address - Street 1:1220 KY HIGHWAY 801 S
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-8720
Practice Address - Country:US
Practice Address - Phone:606-548-0590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XG0600XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGerontology