MEDICARE: JUSTIN WALTERS

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	372600000X	Adult Companion

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	830861600	OTHER	OH	830861600

General Provider Information

NPI Number	:	1962010306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTIN WALTERS

Provider Business Mailing Address
First Line	:	858 NORTHERN PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1759
Country	:	US
Telephone Number	:	513-516-5853
Fax Number	:

Provider Business Practice Location Address
First Line	:	858 NORTHERN PKWY
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1759
Country	:	US
Telephone Number	:	513-516-5853
Fax Number	:

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

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	07/22/2020

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Directions to “ JUSTIN WALTERS ” Practice Location

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