Provider Demographics
NPI:1467563288
Name:WALKER, LESLIE D (OT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:D
Last Name:WALKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:MARCUS HOOK
Mailing Address - State:PA
Mailing Address - Zip Code:19061-4513
Mailing Address - Country:US
Mailing Address - Phone:610-859-9110
Mailing Address - Fax:610-859-8470
Practice Address - Street 1:8019 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2786
Practice Address - Country:US
Practice Address - Phone:215-338-8900
Practice Address - Fax:215-338-8923
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTR001914225XH1200X
DEU1-0001009225X00000X
PAOC010450225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30067867OtherKEYSTONE MERCY
3498602000OtherIBC
DE141156ZB8YOtherMEDICARE
DEP00692889OtherMEDICARE RAILROAD
PA1467563288OtherBRAVO
PAWA369990OtherIBC
PA102306174Medicaid
DE1467563288Medicaid
PA143999VLZOtherMEDICARE
PAP00692889OtherMEDICARE RAILROAD