Basic Information
| Provider Information | |||||||||
| NPI: | 1134398324 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | LISA | ||||||||
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| Credential: | MOTR/L | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1519 132ND ST SE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | EVERETT | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982087203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253579380 | ||||||||
| FaxNumber: | 4253579382 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 NORTHUP WAY | ||||||||
| Address2: | #200 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980041440 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258275877 | ||||||||
| FaxNumber: | 4258275843 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2008 | ||||||||
| LastUpdateDate: | 09/12/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225XH1200X | OT00003732 | WA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225X00000X | OT00003732 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 0404WA | 01 | WA | REGENCE | OTHER | 0089WA | 01 | WA | REGENCE | OTHER | 0257875 | 01 | WA | L&I | OTHER | 0268139 | 01 | WA | DEPT OF L&I | OTHER | 1134398324 | 01 | WA | DSHS | OTHER | 8368714 | 01 | WA | DSHS | OTHER | 9299WA | 01 | WA | REGENCE | OTHER |