MEDICARE: MRS. OTEKA AUSTIN WALTERS M.S., CCC/SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	16389	TX

General Provider Information

NPI Number	:	1396988630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. OTEKA AUSTIN WALTERS M.S., CCC/SLP

Provider Business Mailing Address
First Line	:	6309 JUNEAU RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1613
Country	:	US
Telephone Number	:	817-731-8480
Fax Number	:

Provider Business Practice Location Address
First Line	:	6309 JUNEAU RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76116-1613
Country	:	US
Telephone Number	:	817-731-8480
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	04/16/2009

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