Provider Demographics
NPI:1932363884
Name:WALKER, JACQUELINE HAMILTON (OTR/L)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:HAMILTON
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 1:705 WILSON PKWY
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-2069
Mailing Address - Country:US
Mailing Address - Phone:502-331-9900
Mailing Address - Fax:502-331-0153
Practice Address - Street 1:705 WILSON PKWY
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2069
Practice Address - Country:US
Practice Address - Phone:859-481-1109
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-10
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY R-3155314000000X
KY133163225XE1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XE1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistErgonomics
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY$$$$$$$$$OtherSOCIAL SECURITY