Provider Demographics
NPI:1902890916
Name:WALLS, DONNA JO (OT)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:JO
Last Name:WALLS
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 1:4546 S 14TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-4737
Mailing Address - Country:US
Mailing Address - Phone:325-795-9675
Mailing Address - Fax:325-795-9680
Practice Address - Street 1:4546 S 14TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-4737
Practice Address - Country:US
Practice Address - Phone:325-795-9675
Practice Address - Fax:325-795-9680
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102325225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A005OtherTRICARE
8T1447OtherBCBS
A005OtherTRICARE