Provider Demographics
NPI:1750968426
Name:WALKER, MARCELLE EMILY (OTR/L)
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:EMILY
Last Name:WALKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GRENADA PL
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4304
Mailing Address - Country:US
Mailing Address - Phone:973-699-3474
Mailing Address - Fax:
Practice Address - Street 1:220 LIVINGSTON ST STE 112
Practice Address - Street 2:
Practice Address - City:NORTHVALE
Practice Address - State:NJ
Practice Address - Zip Code:07647-1739
Practice Address - Country:US
Practice Address - Phone:201-564-7515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-26
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00973100225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist