Provider Demographics
NPI:1063749950
Name:WALTZ, MARLENE LESLIE (OTR)
Entity type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:LESLIE
Last Name:WALTZ
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 SUNSET CIR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-8970
Mailing Address - Country:US
Mailing Address - Phone:303-670-1510
Mailing Address - Fax:303-893-8313
Practice Address - Street 1:1916 SUNSET CIR
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:CO
Practice Address - Zip Code:80439-8970
Practice Address - Country:US
Practice Address - Phone:303-670-1510
Practice Address - Fax:303-893-8313
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-12
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1552225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics