MEDICARE: DEVON WILLIAMS OTR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225X00000X	Occupational Therapist	8550	NC

General Provider Information

NPI Number	:	1477993251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVON WILLIAMS OTR

Provider Business Mailing Address
First Line	:	2301 CROWNPOINT EXECUTIVE DR
Second Line	:	SUITE E
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7824
Country	:	US
Telephone Number	:	704-708-8314
Fax Number	:	704-708-8315

Provider Business Practice Location Address
First Line	:	2301 CROWNPOINT EXECUTIVE DR
Second Line	:	SUITE E
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7824
Country	:	US
Telephone Number	:	704-708-8314
Fax Number	:	704-708-8315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	06/26/2013

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