Provider Demographics
NPI:1679347454
Name:WALKER, KAYLIE MACKENZIE (MSOT, OTR/L)
Entity Type:Individual
Prefix:
First Name:KAYLIE
Middle Name:MACKENZIE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MSOT, OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 GREEN MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518-1326
Mailing Address - Country:US
Mailing Address - Phone:484-219-6042
Mailing Address - Fax:
Practice Address - Street 1:450 PHILADELPHIA AVE
Practice Address - Street 2:
Practice Address - City:SHILLINGTON
Practice Address - State:PA
Practice Address - Zip Code:19607-2731
Practice Address - Country:US
Practice Address - Phone:610-796-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOC019427225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist