Provider Demographics
NPI:1992913487
Name:WALTERS, APRIL R (DT)
Entity type:Individual
Prefix:
First Name:APRIL
Middle Name:R
Last Name:WALTERS
Suffix:
Gender:F
Credentials:DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 181
Mailing Address - Street 2:
Mailing Address - City:CHAPIN
Mailing Address - State:IL
Mailing Address - Zip Code:62628-0181
Mailing Address - Country:US
Mailing Address - Phone:217-248-1823
Mailing Address - Fax:
Practice Address - Street 1:812 POPLAR ST.
Practice Address - Street 2:
Practice Address - City:CHAPIN
Practice Address - State:IL
Practice Address - Zip Code:62628
Practice Address - Country:US
Practice Address - Phone:217-248-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILAS23000899P222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist