Provider Demographics
NPI:1417074378
Name:WALKER, PATRICIA (OTR/L)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 W MARLBORO DR
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1836
Mailing Address - Country:US
Mailing Address - Phone:480-861-1414
Mailing Address - Fax:480-247-6576
Practice Address - Street 1:3540 W CHOLLA ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-2099
Practice Address - Country:US
Practice Address - Phone:480-892-9777
Practice Address - Fax:480-635-0222
Is Sole Proprietor?:No
Enumeration Date:2007-03-24
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3858225X00000X, 225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ178131Medicaid