Healthcare Provider Details

I. General information

NPI: 1710154067
Provider Name (Legal Business Name): CHRIS WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2008
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SW 14TH ST
OCALA FL
34471-0615
US

IV. Provider business mailing address

PO BOX 2764
BELLEVIEW FL
34421-2764
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-8300
  • Fax:
Mailing address:
  • Phone: 352-216-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number6684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: