Provider Demographics
NPI:1790258630
Name:WALKER, SHIRLEY
Entity Type:Individual
Prefix:
First Name:SHIRLEY
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 1:6840 DEN MAR LN
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20689-9711
Mailing Address - Country:US
Mailing Address - Phone:240-447-8589
Mailing Address - Fax:
Practice Address - Street 1:6840 DEN MAR LN
Practice Address - Street 2:
Practice Address - City:SUNDERLAND
Practice Address - State:MD
Practice Address - Zip Code:20689-9711
Practice Address - Country:US
Practice Address - Phone:240-447-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03035225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Single Specialty