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General NPI Number Information
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NPI Number | 1538344759
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Entity Type | Organization
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Legal Business Name | RETONYA J. WALTERS
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Dates
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Enumeration Date | 01/07/2008
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Last Update Date | 10/20/2008
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Provider Practice Location Address
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Address Line | 102 N. 2ND
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City | MUSKOGEE
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State | OK
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Zip | 74401-6601
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Country | US
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Telephone | 918-683-5828
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Fax | 918-683-5828
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Provider Business Mailing Address
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Address Line | 205 HERITAGE CT
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City | FORT GIBSON
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State | OK
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Zip | 74434-8409
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Country | US
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Telephone | 918-683-5828
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Fax | 918-683-5828
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Authorized Official
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Title or Position | OWNER
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Name | MS. RETONYA J WALTERS
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Credential |
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Telephone | 918-683-5825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number | NA
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License Number State | OK
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