Basic Information
| Provider Information | |||||||||
| NPI: | 1467563288 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALKER | ||||||||
| FirstName: | LESLIE | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | OT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 W 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MARCUS HOOK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190614513 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6108599110 | ||||||||
| FaxNumber: | 6108598470 | ||||||||
| Practice Location | |||||||||
| Address1: | 8019 FRANKFORD AVE | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191362786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153388900 | ||||||||
| FaxNumber: | 2153388923 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 06/22/2010 | ||||||||
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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 | TR001914 | NJ | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Hand | 225X00000X | U1-0001009 | DE | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 225X00000X | OC010450 | PA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist |
ID Information
| ID | Type | State | Issuer | Description | 30067867 | 01 | PA | KEYSTONE MERCY | OTHER | 3498602000 | 01 | IBC | OTHER | 141156ZB8Y | 01 | DE | MEDICARE | OTHER | P00692889 | 01 | DE | MEDICARE RAILROAD | OTHER | 1467563288 | 01 | PA | BRAVO | OTHER | WA369990 | 01 | PA | IBC | OTHER | 102306174 | 05 | PA | MEDICAID | 1467563288 | 05 | DE | MEDICAID | 143999VLZ | 01 | PA | MEDICARE | OTHER | P00692889 | 01 | PA | MEDICARE RAILROAD | OTHER |