Provider Demographics
NPI:1386809267
Name:TAYLOR-WALKER, OPHELIA
Entity type:Individual
Prefix:
First Name:OPHELIA
Middle Name:
Last Name:TAYLOR-WALKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4505 SE AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73501-8315
Mailing Address - Country:US
Mailing Address - Phone:253-720-5942
Mailing Address - Fax:
Practice Address - Street 1:4505 SE AVALON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-8315
Practice Address - Country:US
Practice Address - Phone:253-720-5942
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3565235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1386809267Medicare PIN