Healthcare Provider Details

I. General information

NPI: 1033432158
Provider Name (Legal Business Name): KAREN WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 03/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 RYAN INDUSTRIAL CT 205
SAN RAMON CA
94583-1772
US

IV. Provider business mailing address

2145 YOUNGS CT
WALNUT CREEK CA
94596-6319
US

V. Phone/Fax

Practice location:
  • Phone: 925-855-9810
  • Fax:
Mailing address:
  • Phone: 925-934-3475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number10177
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: