Provider Demographics
NPI:1538441001
Name:WALKER, ROSA MICHELLE MONTANA (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:MICHELLE MONTANA
Last Name:WALKER
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5079 SE 30TH AVE APT 154
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-4523
Mailing Address - Country:US
Mailing Address - Phone:503-756-7812
Mailing Address - Fax:
Practice Address - Street 1:3600 NORTH INTERSTATE PORTLAND
Practice Address - Street 2:KAISER PERMANENTE CENTRAL INTERSTATE
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1106
Practice Address - Country:US
Practice Address - Phone:360-944-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR287213225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist