Provider Demographics
NPI:1992106645
Name:WALTER, KATHRYN ROSE
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ROSE
Last Name:WALTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ROSE
Other - Last Name:STROHSNITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 MAINSAIL DR APT 2-38
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-3434
Mailing Address - Country:US
Mailing Address - Phone:631-291-0332
Mailing Address - Fax:
Practice Address - Street 1:38 MAINSAIL DR APT 2-38
Practice Address - Street 2:
Practice Address - City:PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-3434
Practice Address - Country:US
Practice Address - Phone:631-291-0332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-12
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3518617252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency