Healthcare Provider Details

I. General information

NPI: 1194343384
Provider Name (Legal Business Name): ANGELIQUE NICOLE WILLIAMS OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC TWENTYNINE PALMS 1145 STURGIS ROAD
TWENTYNINE PALMS CA
92278-8275
US

IV. Provider business mailing address

3108 UPSHUR AVE APT C
TWENTYNINE PALMS CA
92277-9463
US

V. Phone/Fax

Practice location:
  • Phone: 730-830-2117
  • Fax:
Mailing address:
  • Phone: 760-830-2117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: