Provider Demographics
NPI:1295189892
Name:WALKER, MIA PATRICIA (MS, OTR/L)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:PATRICIA
Last Name:WALKER
Suffix:
Gender:F
Credentials:MS, OTR/L
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:AMATANGELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:410 NEW BRIDGE ST STE 10A
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-4700
Mailing Address - Country:US
Mailing Address - Phone:910-347-2212
Mailing Address - Fax:910-338-5013
Practice Address - Street 1:410 NEW BRIDGE ST STE 10A
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-4700
Practice Address - Country:US
Practice Address - Phone:910-347-2212
Practice Address - Fax:910-338-5013
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11311225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist