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NPI Code Detail

MEDICARE: KIAH RAE WALTON

MEDICARE: KIAH RAE WALTON
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
1106S00000XBehavior TechnicianVA

General Provider Information

NPI Number : 1467960849
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIAH RAE WALTON
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number :
Provider Business Practice Location Address
First Line : 46040 CENTER OAK PLZ
Second Line :
City : STERLING
State : VA
Zip : 20166-8539
Country : US
Telephone Number : 703-997-9494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/18/2018
Last Update Date : 01/18/2018

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Directions to “ KIAH RAE WALTON ” Practice Location

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