Provider Demographics
NPI:1881065654
Name:WALKER, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
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 1:7156 W 900 S
Mailing Address - Street 2:
Mailing Address - City:RIDGEVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47380-9628
Mailing Address - Country:US
Mailing Address - Phone:765-644-0500
Mailing Address - Fax:765-378-9019
Practice Address - Street 1:7156 W 900 S
Practice Address - Street 2:
Practice Address - City:RIDGEVILLE
Practice Address - State:IN
Practice Address - Zip Code:47380-9628
Practice Address - Country:US
Practice Address - Phone:765-644-0500
Practice Address - Fax:765-378-9019
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN32001763A224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant