Provider Demographics
NPI:1952097677
Name:WALKER, MAKAYLA CAMRYN (COTA/L)
Entity Type:Individual
Prefix:
First Name:MAKAYLA
Middle Name:CAMRYN
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 1:3775 THISTLEDOWN DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-6543
Mailing Address - Country:US
Mailing Address - Phone:314-496-2671
Mailing Address - Fax:
Practice Address - Street 1:3775 THISTLEDOWN DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-6543
Practice Address - Country:US
Practice Address - Phone:314-496-2671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023013247224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant