Provider Demographics
NPI:1962230250
Name:WALKER, CARLY JOYCE (OTR/L)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:JOYCE
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 1:105 WAXHAW PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-5017
Mailing Address - Country:US
Mailing Address - Phone:704-251-9112
Mailing Address - Fax:704-684-4644
Practice Address - Street 1:105 WAXHAW PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:WAXHAW
Practice Address - State:NC
Practice Address - Zip Code:28173-5017
Practice Address - Country:US
Practice Address - Phone:704-251-9112
Practice Address - Fax:704-684-4644
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC.7383225X00000X
NC17019225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist