Provider Demographics
NPI:1811430341
Name:WALKER, TAMMY (COTA/L)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N SANGAMON AVE
Mailing Address - Street 2:
Mailing Address - City:GIBSON CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60936-1152
Mailing Address - Country:US
Mailing Address - Phone:217-417-2000
Mailing Address - Fax:
Practice Address - Street 1:725 N SANGAMON AVE
Practice Address - Street 2:
Practice Address - City:GIBSON CITY
Practice Address - State:IL
Practice Address - Zip Code:60936-1152
Practice Address - Country:US
Practice Address - Phone:217-417-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL057001785224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant