Provider Demographics
NPI:1134398324
Name:WALKER, LISA (MOTR/L)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MOTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 132ND ST SE
Mailing Address - Street 2:SUITE A
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7203
Mailing Address - Country:US
Mailing Address - Phone:425-357-9380
Mailing Address - Fax:425-357-9382
Practice Address - Street 1:2800 NORTHUP WAY
Practice Address - Street 2:#200
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1440
Practice Address - Country:US
Practice Address - Phone:425-827-5877
Practice Address - Fax:425-827-5843
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT00003732225XH1200X, 225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0404WAOtherREGENCE
WA0089WAOtherREGENCE
WA0257875OtherL&I
WA0268139OtherDEPT OF L&I
WA1134398324OtherDSHS
WA8368714OtherDSHS
WA9299WAOtherREGENCE
WA0404WAOtherREGENCE
WA0257875OtherL&I
WA8368714OtherDSHS
WA9299WAOtherREGENCE