Provider Demographics
NPI:1306222021
Name:WALKER, LISA ANN (MHA, OTR/L)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:WALKER
Suffix:
Gender:F
Credentials:MHA, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19031 33RD AVE W STE 102
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4724
Mailing Address - Country:US
Mailing Address - Phone:425-741-0056
Mailing Address - Fax:425-741-0057
Practice Address - Street 1:19031 33RD AVE W STE 102
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4724
Practice Address - Country:US
Practice Address - Phone:425-741-0056
Practice Address - Fax:425-741-0057
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003143225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2117235Medicaid