Provider Demographics
NPI:1710444898
Name:WALKER, AMY (COTA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 ROUTE 44 55
Mailing Address - Street 2:
Mailing Address - City:CLINTONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:12515-5141
Mailing Address - Country:US
Mailing Address - Phone:845-883-7457
Mailing Address - Fax:
Practice Address - Street 1:1153 ROUTE 44 55
Practice Address - Street 2:
Practice Address - City:CLINTONDALE
Practice Address - State:NY
Practice Address - Zip Code:12515-5141
Practice Address - Country:US
Practice Address - Phone:845-883-7457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA15756225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist