Provider Demographics
NPI:1780990150
Name:WALTZ, KERSTIN (OT)
Entity type:Individual
Prefix:MRS
First Name:KERSTIN
Middle Name:
Last Name:WALTZ
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9501 OLD ANNAPOLIS RD STE 125
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-6355
Mailing Address - Country:US
Mailing Address - Phone:410-997-1063
Mailing Address - Fax:410-997-1408
Practice Address - Street 1:9501 OLD ANNAPOLIS RD STE 125
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-6355
Practice Address - Country:US
Practice Address - Phone:410-997-1063
Practice Address - Fax:410-997-1408
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05519225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist