Provider Demographics
NPI:1104664044
Name:WALKER, JENNIFER (MOT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WALKER
Suffix:
Gender:F
Credentials:MOT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1061 N COLEMAN ST STE 80
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2328
Mailing Address - Country:US
Mailing Address - Phone:469-481-6304
Mailing Address - Fax:469-466-6417
Practice Address - Street 1:1061 N COLEMAN ST STE 80
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2328
Practice Address - Country:US
Practice Address - Phone:469-481-6304
Practice Address - Fax:469-466-6417
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110833225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist