Provider Demographics
NPI:1235443912
Name:WALKER, DANIELLE LYNETTE
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LYNETTE
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 E 21ST ST UNIT 616
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-4981
Mailing Address - Country:US
Mailing Address - Phone:312-399-7453
Mailing Address - Fax:
Practice Address - Street 1:320 E 21ST ST UNIT 616
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-4981
Practice Address - Country:US
Practice Address - Phone:312-399-7453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL056.008713225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist