MEDICARE: MRS. COURTNEY ANN WALKER MOTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225XP0200X	Pediatric Occupational Therapist	115497	TX

General Provider Information

NPI Number	:	1528405859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. COURTNEY ANN WALKER MOTR

Provider Business Mailing Address
First Line	:	4600 LOCKHILL SELMA RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2185
Country	:	US
Telephone Number	:	210-408-7300
Fax Number	:	210-408-7303

Provider Business Practice Location Address
First Line	:	4600 LOCKHILL SELMA RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2185
Country	:	US
Telephone Number	:	210-408-7300
Fax Number	:	210-408-7303

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2013
Last Update Date	:	05/28/2013

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