Provider Demographics
NPI:1063738425
Name:WALKER, COLETTE RUSH (OTR/L)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:RUSH
Last Name:WALKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 57
Mailing Address - Street 2:
Mailing Address - City:GOOCHLAND
Mailing Address - State:VA
Mailing Address - Zip Code:23063-0057
Mailing Address - Country:US
Mailing Address - Phone:804-556-7181
Mailing Address - Fax:804-556-7182
Practice Address - Street 1:1940 SANDY HOOK RD
Practice Address - Street 2:SUITE F
Practice Address - City:GOOCHLAND
Practice Address - State:VA
Practice Address - Zip Code:23063-3100
Practice Address - Country:US
Practice Address - Phone:904-556-7181
Practice Address - Fax:804-556-7182
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-09
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0119002448225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist