Basic Information
| Provider Information | |||||||||
| NPI: | 1619547080 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | WOLTER | ||||||||
| FirstName: | EMMA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1485 E OLIVE BRANCH RD | ||||||||
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| City: | NEWBERRY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 474497075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8125930991 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3710 KENNETH SIMPSON LN | ||||||||
| Address2: | |||||||||
| City: | BEDFORD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122757006 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2021 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225X00000X | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | 31007429A | IN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
No ID Information.