Healthcare Provider Details

I. General information

NPI: 1124660493
Provider Name (Legal Business Name): VICTORIA ANN WALTERS MSOT, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2019
Last Update Date: 02/10/2022
Certification Date: 02/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 OLD BROADWAY
HASTINGS ON HUDSON NY
10706-3801
US

IV. Provider business mailing address

129 PARKSIDE DR
SUFFERN NY
10901-7839
US

V. Phone/Fax

Practice location:
  • Phone: 914-478-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number024088
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number024088
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code225XP0019X
TaxonomyPhysical Rehabilitation Occupational Therapist
License Number46TR00903200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: