Provider Demographics
NPI:1609038165
Name:OGLE WALKER, MARY RACHELLE (MPT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RACHELLE
Last Name:OGLE WALKER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 BLACKBERRY RD
Mailing Address - Street 2:
Mailing Address - City:SARCOXIE
Mailing Address - State:MO
Mailing Address - Zip Code:64862-8381
Mailing Address - Country:US
Mailing Address - Phone:417-540-3564
Mailing Address - Fax:
Practice Address - Street 1:2660 E 32ND ST STE 104
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-4361
Practice Address - Country:US
Practice Address - Phone:417-540-3564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029647225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist