Provider Demographics
NPI:1447614847
Name:WALKER, OLYDIA ALEESE (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:OLYDIA
Middle Name:ALEESE
Last Name:WALKER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 WINDFIELD GLN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30088-3336
Mailing Address - Country:US
Mailing Address - Phone:770-873-7996
Mailing Address - Fax:
Practice Address - Street 1:1503 WINDFIELD GLN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30088-3336
Practice Address - Country:US
Practice Address - Phone:770-873-7996
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2016-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0025962255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer