Healthcare Provider Details

I. General information

NPI: 1225487796
Provider Name (Legal Business Name): KATIE WILLIAMS OT/L
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE WILLIAMS

II. Dates (important events)

Enumeration Date: 06/06/2016
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4447 E 300 N
RIGBY ID
83442-5512
US

IV. Provider business mailing address

115 E 116TH ST APT 1C
NEW YORK NY
10029-1308
US

V. Phone/Fax

Practice location:
  • Phone: 208-339-5283
  • Fax:
Mailing address:
  • Phone: 208-339-5283
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number020248
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberU1-0012463
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT-1314
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: