Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | OT-1546 | ID |
NPI | 1104281500 |
---|---|
Provider Name | Mrs. Marilee Ann Walker |
First Address | Eagle, ID 83616-5838 |
Second Address | Wilsonville, OR 97070-9697 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/12/2015 |
Last Update Date | 30/12/2015 |