Provider Demographics
NPI:1669030243
Name:WALKINGTON, BRITTNEY HELEN (COTA/L)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:HELEN
Last Name:WALKINGTON
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 E PLUM ST
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:IL
Mailing Address - Zip Code:62012-1172
Mailing Address - Country:US
Mailing Address - Phone:618-946-9139
Mailing Address - Fax:
Practice Address - Street 1:116 E PLUM ST
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:IL
Practice Address - Zip Code:62012-1172
Practice Address - Country:US
Practice Address - Phone:618-946-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057005199224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL971252204OtherUNITED HEALTHCARE CHOICE PLUS