Provider Demographics
NPI:1346311503
Name:WALTERS, LAURIE S (OTR/L, CHT)
Entity type:Individual
Prefix:MRS
First Name:LAURIE
Middle Name:S
Last Name:WALTERS
Suffix:
Gender:F
Credentials:OTR/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:206-860-5414
Mailing Address - Fax:206-720-8462
Practice Address - Street 1:21401 72ND AVE W
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7702
Practice Address - Country:US
Practice Address - Phone:425-412-1874
Practice Address - Fax:425-412-1864
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00002391225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0276241OtherL&I
WA292144OtherL&I
WA0276242OtherL&I
WA0276246OtherL&I
WA0276246OtherL&I
WAG8899850Medicare PIN
WA0276242OtherL&I