Provider Demographics
NPI:1568011484
Name:WALKER, OCTAVIA OLVIA
Entity Type:Individual
Prefix:
First Name:OCTAVIA
Middle Name:OLVIA
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 1:2250 W VIRGINIA ST APT 712
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-4644
Mailing Address - Country:US
Mailing Address - Phone:409-566-0499
Mailing Address - Fax:
Practice Address - Street 1:2250 W VIRGINIA ST APT 712
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-4644
Practice Address - Country:US
Practice Address - Phone:409-566-0499
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider