=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619928645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMI MARIE WALTERS MOT, OTR/L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3615 SPICER DR SE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97322-7043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-967-7551
-----------------------------------------------------
Fax | 541-967-5095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3615 SPICER DR SE
-----------------------------------------------------
City | ALBANY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97322-7043
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-967-7551
-----------------------------------------------------
Fax | 541-967-5095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 2261
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------