Provider Demographics
NPI:1558743567
Name:WALKER, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4300 LEGENDARY DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-8604
Mailing Address - Country:US
Mailing Address - Phone:504-274-9544
Mailing Address - Fax:850-460-8703
Practice Address - Street 1:4300 LEGENDARY DR
Practice Address - Street 2:SUITE 208
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-8604
Practice Address - Country:US
Practice Address - Phone:504-274-9544
Practice Address - Fax:850-460-8703
Is Sole Proprietor?:No
Enumeration Date:2015-06-25
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 17142225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics