Healthcare Provider Details

I. General information

NPI: 1942068689
Provider Name (Legal Business Name): MICAH WALKER OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2024
Last Update Date: 05/08/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 SR SEMORAN BLVD STE 39
ORLANDO FL
32822
US

IV. Provider business mailing address

2083 LACEY OAK DR
APOPKA FL
32703-3609
US

V. Phone/Fax

Practice location:
  • Phone: 407-281-0228
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number25779
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: