Provider Demographics
NPI:1861260978
Name:WALTER, MASON CHRISTOPH (COTA)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:CHRISTOPH
Last Name:WALTER
Suffix:
Gender:M
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E COURT AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-2068
Mailing Address - Country:US
Mailing Address - Phone:515-381-9278
Mailing Address - Fax:
Practice Address - Street 1:600 E COURT AVE STE 120
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-2068
Practice Address - Country:US
Practice Address - Phone:515-381-9278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant