=====================================================
General NPI Number Information
=====================================================
NPI Number | 1972634210
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALKER THERAPY CLINIC, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/08/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 117 FINANCIAL DR
-----------------------------------------------------
City | CABOT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72023-8668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-941-3601
-----------------------------------------------------
Fax | 501-941-0992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 117 FINANCIAL DR
-----------------------------------------------------
City | CABOT
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 72023-8668
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 501-941-3601
-----------------------------------------------------
Fax | 501-941-0992
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | AMANDA L WALKER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 501-941-3601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | OTR1337
-----------------------------------------------------
License Number State | AR
-----------------------------------------------------