Healthcare Provider Details

I. General information

NPI: 1790258630
Provider Name (Legal Business Name): SHIRLEY WALKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 01/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 DEN MAR LN
SUNDERLAND MD
20689-9711
US

IV. Provider business mailing address

6840 DEN MAR LN
SUNDERLAND MD
20689-9711
US

V. Phone/Fax

Practice location:
  • Phone: 240-447-8589
  • Fax:
Mailing address:
  • Phone: 240-447-8589
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number03035
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: