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NPI Code Detail

MEDICARE: KATHERINE WOLTER MT-BC

MEDICARE: KATHERINE WOLTER MT-BC
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
1225A00000XMusic Therapist19078IN

General Provider Information

NPI Number : 1356150288
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE WOLTER MT-BC
Provider Business Mailing Address
First Line : 5534 DONATELLO DR 92
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-9220
Country : US
Telephone Number : 260-442-6545
Fax Number :
Provider Business Practice Location Address
First Line : 1400 AIRPORT NORTH OFFICE PARK STE D
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-6723
Country : US
Telephone Number : 260-702-9141
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/06/2025
Last Update Date : 01/06/2025

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