Provider Demographics
NPI:1871720474
Name:WALKER, EDI ELLINGTON (OT)
Entity type:Individual
Prefix:MS
First Name:EDI
Middle Name:ELLINGTON
Last Name:WALKER
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14401 SW 79TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-4403
Mailing Address - Country:US
Mailing Address - Phone:352-495-3800
Mailing Address - Fax:
Practice Address - Street 1:14401 SW 79TH ST
Practice Address - Street 2:
Practice Address - City:ARCHER
Practice Address - State:FL
Practice Address - Zip Code:32618-4403
Practice Address - Country:US
Practice Address - Phone:352-495-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT9732225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist