Provider Demographics
NPI:1265278741
Name:WALKER, DEANNA NICOLE (COTA/L, AC, CPRCS)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:NICOLE
Last Name:WALKER
Suffix:
Gender:F
Credentials:COTA/L, AC, CPRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 WOODLAKE DR NE APT 101
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3067
Mailing Address - Country:US
Mailing Address - Phone:321-914-6852
Mailing Address - Fax:
Practice Address - Street 1:1500 WOODLAKE DR NE APT 101
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-3067
Practice Address - Country:US
Practice Address - Phone:321-914-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOTA18239224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant