MEDICARE: MICHELLE 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	103K00000X	Behavior Analyst	0125063	IN

General Provider Information

NPI Number	:	1083978548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE WALTERS

Provider Business Mailing Address
First Line	:	7128 SEA PINE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-4138
Country	:	US
Telephone Number	:	630-205-4356
Fax Number	:	317-842-4428

Provider Business Practice Location Address
First Line	:	7128 SEA PINE DR
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-4138
Country	:	US
Telephone Number	:	630-205-4356
Fax Number	:	317-842-4428

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

Provider Enumeration Date	:	06/29/2012
Last Update Date	:	04/04/2019

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Directions to “ MICHELLE WALTERS ” Practice Location

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