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General NPI Number Information
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NPI Number | 1689370785
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Entity Type | Individual
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Provider Name | MS. SHANA J WALKER
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Gender | Female
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 1701 PARK CENTER DR STE 230
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City | ORLANDO
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State | FL
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Zip | 32835-6235
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Country | US
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Telephone | 386-507-1102
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Fax |
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Provider Business Mailing Address
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Address Line | 505 S BROOKS AVE
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City | DELAND
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State | FL
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Zip | 32720-6607
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Country | US
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Telephone | 386-507-1102
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 224Z00000X
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Taxonomy Name | Occupational Therapy Assistant
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License Number | OTA17410
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License Number State | FL
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