MEDICARE: MRS. NICHOLA STEPHANIE WALKER OTR/L

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	007653-1	NY

General Provider Information

NPI Number	:	1922374289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NICHOLA STEPHANIE WALKER OTR/L

Provider Business Mailing Address
First Line	:	2211 HOFFMAN AVE
Second Line	:
City	:	ELMONT
State	:	NY
Zip	:	11003-2906
Country	:	US
Telephone Number	:	516-972-5536
Fax Number	:

Provider Business Practice Location Address
First Line	:	3117 AVENUE W
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11229-5918
Country	:	US
Telephone Number	:	718-648-8804
Fax Number	:	718-648-8804

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2012
Last Update Date	:	03/30/2012

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