Provider Demographics
NPI:1891255808
Name:WALKER, BRANDY ANNETTE
Entity Type:Individual
Prefix:
First Name:BRANDY
Middle Name:ANNETTE
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 1:1619 WOODLAWN WAY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9574
Mailing Address - Country:US
Mailing Address - Phone:224-436-6974
Mailing Address - Fax:
Practice Address - Street 1:1619 WOODLAWN WAY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9574
Practice Address - Country:US
Practice Address - Phone:224-436-6974
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2019-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist