Healthcare Provider Details

I. General information

NPI: 1508778739
Provider Name (Legal Business Name): WALKER PAUL FLADT OTR/L
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 JOLIET ST
DYER IN
46311-1996
US

IV. Provider business mailing address

2001 BUTTERFIELD RD STE 1600
DOWNERS GROVE IL
60515-1211
US

V. Phone/Fax

Practice location:
  • Phone: 219-864-3300
  • Fax: 219-864-2567
Mailing address:
  • Phone: 219-864-3300
  • Fax: 219-864-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number31009180A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: