Provider Demographics
NPI:1104240001
Name:WALKER, WILLIAM LEANDER (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEANDER
Last Name:WALKER
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 SAGE BRUSH RD
Mailing Address - Street 2:
Mailing Address - City:YUKON
Mailing Address - State:OK
Mailing Address - Zip Code:73099-6869
Mailing Address - Country:US
Mailing Address - Phone:405-620-6740
Mailing Address - Fax:405-354-6607
Practice Address - Street 1:609 SAGE BRUSH RD
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-6869
Practice Address - Country:US
Practice Address - Phone:405-620-6740
Practice Address - Fax:405-354-6607
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4932255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer