Provider Demographics
NPI:1023233079
Name:WALTHER, KARA LYNN (OTRL)
Entity type:Individual
Prefix:MRS
First Name:KARA
Middle Name:LYNN
Last Name:WALTHER
Suffix:
Gender:F
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15052 ROAD 5
Mailing Address - Street 2:
Mailing Address - City:PANDORA
Mailing Address - State:OH
Mailing Address - Zip Code:45877-9748
Mailing Address - Country:US
Mailing Address - Phone:419-384-3415
Mailing Address - Fax:
Practice Address - Street 1:1880 N PERRY ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OTTAWA
Practice Address - State:OH
Practice Address - Zip Code:45875-1129
Practice Address - Country:US
Practice Address - Phone:419-523-9003
Practice Address - Fax:419-523-9143
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOT2672174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist